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A fourth wave of the opioid epidemic is coming, a national expert on drug use and policy said during a virtual panel buy levitra 5mg discussion this week hosted by the Berkshire County, Massachusetts, District Attorney’s Office and the Berkshire Opioid levitra adverse effects Addiction Prevention Collaborative.Dr. Daniel Ciccarone, a professor of family and community medicine at the University of California, San Francisco (UCSF) School of Medicine, said the next wave in the country’s opioid health emergency will focus on stimulants like buy levitra 5mg methamphetamine and cocaine, and drug combinations where stimulants are used in conjunction with opioids.“The use of methamphetamines is back and it’s back big time,” said Ciccarone, whose most recent research has focused on heroin use.Previously, officials had said there were three waves of the opioid epidemic – the first being prescription pills, the second being heroin, and the third being synthetic drugs, like fentanyl.Now, Ciccarone said, what federal law enforcement and medical experts are seeing is an increase in the use of stimulants, especially methamphetamines.The increase in deaths due to stimulants may be attributed to a number of causes. The increase in supply, both imported and domestically produced, as well as the increase of the drugs’ potency.“Meth’s purity and potency has gone up to historical levels,” he said. €œAs of 2018, we’ve reached buy levitra 5mg unseen heights of 97 percent potency and 97 percent purity.

In a prohibitionist world, we should not be seeing such high quality. This is almost buy levitra 5mg pharmaceutical quality.”Additionally, law enforcement and public health experts like Ciccarone are seeing an increase in the co-use of stimulants with opioids, he said. Speedballs, cocaine mixed with heroin, and goofballs, methamphetamines used with heroin or fentanyl, are becoming more common from the Midwest into Appalachia and up through New England, he said.Federal law enforcement officials are recommending local communities prepare for the oncoming rise in illegal drugs coming into their communities.“Some people will use them both at the same time, but some may use them in some combination regularly,” he said. €œThey may use meth in the morning to go to work, and use heroin at night to come down.”The co-use, he said, was an organic response to the fentanyl overdose epidemic.“Some of the things that we heard … is that meth is popularly construed as helping to decrease heroin and buy levitra 5mg fentanyl use.

Helping with heroin withdraw symptoms and helping with heroin overdoses,” he said. €œWe debated this for many years that people were using stimulants to reverse overdoses – we’re hearing it again.”“Supply is up, purity is up, price is down,” buy levitra 5mg he said. €œWe know from economics that when drug patterns go in that direction, use is going up.”Ciccarone said that there should not be deaths because of stimulants, but that heroin/fentanyl is the deadly element in the equation.His recommendations to communities were not to panic, but to lower the stigma surrounding drug use in order to affect change. Additionally, he said, policies should focus buy levitra 5mg on reduction.

supply reduction, demand reduction and harm reduction. But not focus on only one single drug.Additionally, he said that by addressing buy levitra 5mg issues within communities and by healing communities socially, economically and spiritually, communities can begin to reduce demand.“We’ve got to fix the cracks in our society, because drugs fall into the cracks,” he said.Shutterstock U.S. Rep. Annie Kuster (D-NH) recently held two virtual roundtables addressing how COVID-19 has affected New Hampshire’s healthcare industry.“The health and economic crisis caused by COVID-19 has created buy levitra 5mg significant challenges for Granite State healthcare, mental health, and substance use treatment providers — at the same time, we are seeing increases in substance abuse and mental illness across New Hampshire,” Kuster said.

€œFrom the transition to telehealth care and cancellations of elective procedures to a lack of personal protective equipment and increasing health needs of our communities buy levitra 5mg – providers have overcome a multitude of obstacles due to COVID-19 in recent months. I was glad to hear from these hard-working Granite Staters, whose insights will continue to guide my work in Congress as we respond to this pandemic. I’m committed to ensuring that communities across New Hampshire can safely access the care and treatment they deserve.”The first roundtable addressed substance-use disorder (SUD) and mental buy levitra 5mg health.The second virtual roundtable was an opportunity for health care providers to speak about their workplace challenges during the pandemic. Kuster is the founder and co-chairwoman of the Bipartisan Opioid Task Force, which held a virtual discussion in June on the opioid crisis and the pandemic.Shutterstock Opioid prescription rates for outpatient knee surgery vary nationwide, according to a study recently published in BMJ Open.

€œWe found massive levels of variation in the proportion of patients who are prescribed opioids between states, even after adjusting for nuances of the procedure and differences buy levitra 5mg in patient characteristics,” said Dr. M. Kit Delgado, the study’s senior author and an assistant buy levitra 5mg professor of Emergency Medicine and Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. €œWe’ve also seen that the average number of pills prescribed was extremely high for outpatient procedures of this type, particularly for patients who had not been taking opioids prior to surgery.”Researchers examined insurance claims for nearly 100,000 patients who had arthroscopic knee surgery between 2015 and 2019 and had not used any opioid prescriptions in the six months before the surgery.Within three days of a procedure, 72 percent of patients filled an opioid prescription.

High prescription rates were found in the Midwest and the Rocky Mountain regions buy levitra 5mg. The coasts had lower rates.Nationwide, the average prescription strength was equivalent to 250 milligrams of morphine over five days. This is buy levitra 5mg the threshold for increased risk of opioid overdose death, according to the Centers for Disease Control and Prevention.Shutterstock U.S. Secretary of Labor Eugene Scalia awarded nearly $20 million to four states significantly impacted by the opioid crisis, the Department of Labor announced Thursday.

The Florida buy levitra 5mg Department of Economic Opportunity, the Maryland Department of Labor, the Ohio Department of Job and Family Services, and the Wisconsin Department of Workforce Development were awarded the money as part of the DOL’s “Support to Communities. Fostering Opioid Recovery through Workforce Development” created after the passage of the SUPPORT for Patients and Communities Act of 2018. The money will be used to retrain buy levitra 5mg workers in areas with high rates of substance use disorders. At a press conference in Piketon, Ohio, Scalia said the DOL had awarded Ohio’s Department of Job buy levitra 5mg and Family Services $5 million to help communities in southern Ohio combat the opioid crisis in that area.

€œToday’s funding represents this Administration’s continued commitment to serving those most in need,” said Assistant Secretary for Employment and Training John Pallasch. €œThe U.S buy levitra 5mg. Department of Labor is taking a strong stand to support individuals and communities impacted by the crisis.”Grantees will use the funds to collaborate with community partners, such as employers, local workforce development boards, treatment and recovery centers, law enforcement officials, faith-based community organizations, and others, to address the economic effects of substance misuse, opioid use, addiction, and overdose.Shutterstock CVS Health has completed the installation of time-delayed safe technology at all 446 Massachusetts locations as part of its initiatives aimed at reducing the misuse and diversion of prescription medications in Massachusetts, the company announced Thursday. The safes are intended to prevent robberies of controlled substance medications, such as oxycodone and hydrocodone, by electronically delaying the time it takes for pharmacy employees to open the safe where those drugs are buy levitra 5mg stored.The company also announced that it had added 50 new medication disposal units in select stores throughout Massachusetts.

Those units join 106 secure disposal units previously installed at CVS locations across the state and another 43 units previously donated to Massachusetts law enforcement agencies. The company plans to install another six units in stores by buy levitra 5mg the year’s end. €œWhile our nation and our company focus on COVID-19 treatment, testing, and other measures to prevent community transmission of the virus, the misuse of prescription drugs remains an ongoing challenge in Massachusetts and elsewhere that warrants our continued attention,” said John Hering, Region Director for CVS Health. €œThese steps to reduce the theft and diversion of opioid medications bring added security to our stores and more disposal options for our communities.”In 2015, CVS implemented time-delayed safe technology in CVS pharmacies across Indianapolis in response to the high volume of buy levitra 5mg pharmacy robberies in that city.

The company saw a 70 percent decline in pharmacy robberies in stores where the time-delayed safes were installed. Since then, the company has installed 4,760 time-delayed safes in 15 states and the District of buy levitra 5mg Columbia and has seen a 50 percent decline in pharmacy robberies in those areas. The company said it would add an additional 1,000 in-store medication disposal units to the 2,500 units it currently has in CVS pharmacies nationwide. The units allow customers to drop unused prescriptions into a safe place for their disposal to prevent those drugs from being misused.

CVS stores that do not offer medication disposal units offer all customers filling opioid prescriptions for the first time with DisposeRX packets that effectively and efficiently breakdown unused drugs into a biodegradable gel for safe disposal in the trash at home..

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At a levitra discount canada glance. Medicare enrollment in Hawaii How levitra discount canada many Hawaiians are enrolled in Medicare?. As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.For most Americans, filing for Medicare is part of turning 65.

But Medicare coverage is also available to people under the age of 65 who have been receiving disability benefits for at levitra discount canada least two years, or who have ALS or end-stage renal disease. Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.Medicare levitra discount canada Advantage in HawaiiIn Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide.

The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2020, Medicare beneficiaries can select levitra discount canada from among 20 different Medicare Advantage plans. But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so.

And there is another window — the Medicare Advantage open enrollment period (January levitra discount canada 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in HawaiiMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless of age in levitra discount canada Hawaii.

Federal law grants a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a levitra discount canada result of a disability. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability.

So while it’s common to see under-65 Medigap policies sold in other states with premiums that are well above the age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs levitra discount canada. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare levitra discount canada Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage.

Stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer). The annual open enrollment period that levitra discount canada runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan. Medicare spending in HawaiiAs of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971.

Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, levitra discount canada Oklahoma, and Louisiana). That’s according to data that were standardized to account for regional differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii. Resources for Medicare beneficiaries levitra discount canada and caregiversQuestions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii?.

You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for levitra discount canada healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

At a buy levitra 5mg glance. Medicare enrollment in Hawaii How many Hawaiians are buy levitra 5mg enrolled in Medicare?. As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.For most Americans, filing for Medicare is part of turning 65. But Medicare coverage is also available to people under the age buy levitra 5mg of 65 who have been receiving disability benefits for at least two years, or who have ALS or end-stage renal disease.

Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their buy levitra 5mg age.Medicare Advantage in HawaiiIn Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2020, Medicare beneficiaries can select from among 20 different Medicare Advantage plans buy levitra 5mg.

But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan buy levitra 5mg and enroll in Original Medicare instead.Medigap in HawaiiMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless buy levitra 5mg of age in Hawaii.

Federal law grants a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of a disability buy levitra 5mg. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability. So while it’s common to see under-65 Medigap policies sold in other states with premiums that are well above the buy levitra 5mg age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs.

But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare Part D buy levitra 5mg coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage. Stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer). The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to buy levitra 5mg a different Part D plan.

Medicare spending in HawaiiAs of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in buy levitra 5mg Florida, Texas, Mississippi, Oklahoma, and Louisiana). That’s according to data that were standardized to account for regional differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii. Resources for Medicare beneficiaries and caregiversQuestions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii? buy levitra 5mg.

You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens buy levitra 5mg of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

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Today, under generic levitra tablets the leadership of President Trump, levitra savings the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the levitra savings latest update in the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs.

Other resources levitra savings are also being dedicated to support training, mentorship and safety improvements in nursing homes."The Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary Alex Azar. "By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have levitra savings to apply to receive a share of this $2 billion incentive payment allocation.

HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.QualificationsIn order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare &. Medicaid Services (CMS) levitra savings. HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that levitra savings will be used to establish eligibility and collect necessary provider data to inform payment.

Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).Performance and Payment CycleThe incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month's performance period.MethodologyUsing data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing homes against a baseline level of infection in the community where a given levitra savings facility is located. CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity.

Against this baseline, facilities levitra savings will have their performance measured on two outcomes. Ability to keep new COVID infection rates low among residents. Ability to keep COVID mortality low among residents.To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued levitra savings guidance in early May requiring that certified nursing facilities submit data to the NHSN COVID-19 Module.

Data from this module will be used to assess nursing home performance and determine incentive payments.HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck levitra savings Protection Program and Health Care Enhancement Act. Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here).For updates and to learn more about the Provider Relief Program, visit. Hhs.gov/providerrelief.Start Preamble Start Printed Page 55292 Centers levitra savings for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS).

Agency Order. The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces the issuance of an Order under Section 361 of the Public Health Service Act to temporarily halt residential evictions to prevent the further spread of COVID-19. This Order is effective September 4, 2020 through December 31, 2020 levitra savings. Start Further Info Nina Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H21-10, Atlanta, GA 30329.

Telephone. 404-639-7000. Email. Cdcregulations@cdc.gov.

End Further Info End Preamble Start Supplemental Information Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths. Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease.

The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal.

People of any age with certain underlying medical conditions, such as cancer, an immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health. According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these best efforts, COVID-19 continues to spread and further action is needed.

In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition. They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19.

The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19. Applicability Under this Order, a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. This Order does not apply in any State, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order.

Nor does this order apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. In accordance with 42 U.S.C. 264(e), this Order does not preclude State, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order. This Order is a temporary eviction moratorium to prevent the further spread of COVID-19.

This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Renter's or Homeowner's Declaration Attachment A is a Declaration form that tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions to prevent the further spread of COVID-19 may use. To invoke the CDC's order these persons must provide an executed copy of the Declaration form (or a similar declaration under penalty of perjury) to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live.

Each adult listed on the lease, rental agreement, or housing contract should likewise complete and provide a declaration. Unless the CDC order is extended, changed, or ended, the order prevents these persons from being evicted or removed from where they are living through December 31, 2020. These persons are still required to pay rent and follow all the other terms of their lease and rules of the place where they live. These persons may also still be evicted for reasons other than not paying rent or making a housing Start Printed Page 55293payment.

Executed declarations should not be returned to the Federal Government. Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2 Temporary Halt in Residential Evictions To Prevent the Further Spread of COVID-19 Summary Notice and Order. And subject to the limitations under “Applicability”.

Under 42 CFR 70.2, a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member. €œAvailable housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate Federal, State, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. €œCovered person” [] means any tenant, lessee, or resident of a residential property who provides to their landlord, the owner of the residential property, or other person with a legal right to pursue eviction or a possessory action, a declaration under penalty of perjury indicating that.

(1) The individual has used best efforts to obtain all available government assistance for rent or housing. (2) The individual either (i) expects to earn no more than $99,000 in annual income for Calendar Year 2020 (or no more than $198,000 if filing a joint tax return),[] (ii) was not required to report any income in 2019 to the U.S. Internal Revenue Service, or (iii) received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act. (3) the individual is unable to pay the full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, a lay-off, or extraordinary [] out-of-pocket medical expenses.

(4) the individual is using best efforts to make timely partial payments that are as close to the full payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses. And (5) eviction would likely render the individual homeless—or force the individual to move into and live in close quarters in a new congregate or shared living setting—because the individual has no other available housing options. €œEvict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or a possessory action, to remove or cause the removal of a covered person from a residential property. This does not include foreclosure on a home mortgage.

€œResidential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park, or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the State, territorial, tribal, or local jurisdiction. €œState” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives.

Mitigating the spread of COVID-19 within congregate or shared living settings, or through unsheltered homelessness. Mitigating the further spread of COVID-19 from one U.S. State or U.S. Territory into any other U.S.

State or U.S. Territory. And supporting response efforts to COVID-19 at the Federal, State, local, territorial, and tribal levels. Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S.

Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths. Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease. The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks.

Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal. People of any age with certain underlying medical conditions, such as cancer, an Start Printed Page 55294immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health.

According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these significant efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease.

Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition. They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into close quarters in congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. Applicability This Order does not apply in any State, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order.

In accordance with 42 U.S.C. 264(e), this Order does not preclude State, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order. Additionally, this Order shall not apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. This Order is a temporary eviction moratorium to prevent the further spread of COVID-19.

This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Nothing in this Order precludes evictions based on a tenant, lessee, or resident. (1) Engaging in criminal activity while on the premises.

(2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property. (4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Eviction and Risk of COVID-19 Transmission Evicted renters must move, which leads http://cz.keimfarben.de/buy-cheap-levitra/ to multiple outcomes that increase the risk of COVID-19 spread.

Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. According to the Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding.[] Studies show that COVID-19 transmission occurs readily within households. Household contacts are estimated to be 6 times more likely to become infected by an index case of COVID-19 than other close contacts.[] Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing, and domestic violence and abuse shelters.

Special considerations exist for such housing because of the challenges of maintaining social distance. Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, cognitive decline, or no access to technology, and thus may find it more difficult to take actions to protect themselves from COVID-19. CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms.[] Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures.

Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136) to aid individuals and businesses adversely affected by COVID-19. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with Federal assistance or federally related financing.

These protections helped alleviate the public health consequences of tenant displacement during the COVID-19 pandemic. The CARES Act eviction moratorium expired on July 24, 2020.[] The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and local officials using emergency powers. Researchers estimated that this temporary Federal moratorium provided relief to a material portion of the nation's roughly 43 million renters.[] Start Printed Page 55295Approximately 12.3 million rental units have federally backed financing, representing 28% of renters. Other data show more than 2 million housing vouchers along with approximately 2 million other federally assisted rental units.[] The Federal moratorium, however, did not reach all renters.

Many renters who fell outside the scope of the Federal moratorium were protected under State and local moratoria. In the absence of State and local protections, as many as 30-40 million people in America could be at risk of eviction.[] A wave of evictions on that scale would be unprecedented in modern times.[] A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus contributing to the spread of COVID-19. The statistics on interstate moves show that mass evictions would likely increase the interstate spread of COVID-19. Over 35 million Americans, representing approximately 10% of the U.S.

Population, move each year.[] Approximately 15% of moves are interstate.[] Eviction, Homelessness, and Risk of Severe Disease From COVID-19 Evicted individuals without access to housing or assistance options may also contribute to the homeless population, including older adults or those with underlying medical conditions, who are more at risk for severe illness from COVID-19 than the general population.[] In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Among people who entered shelters throughout the United States in 2017, 27% were staying with family or friends beforehand.[] People experiencing homelessness are a high-risk population. It may be more difficult for these persons to consistently access the necessary resources in order to adhere to public health recommendations to prevent COVID-19. For instance, it may not be possible to avoid certain congregate settings such as homeless shelters, or easily access facilities to engage in handwashing with soap and water.

Extensive outbreaks of COVID-19 have been identified in homeless shelters.[] In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members.[] In Boston, Massachusetts, universal COVID-19 testing at a single shelter revealed 147 cases, representing 36% of shelter residents.[] COVID-19 testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested).[] Throughout the United States, among 208 shelters reporting universal diagnostic testing data, 9% of shelter clients have tested positive.[] CDC guidance recommends increasing physical distance between beds in homeless shelters.[] To adhere to this guidance, shelters have limited the number of people served throughout the United States. In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above. The challenge of mitigating disease transmission in homeless shelters has been compounded because some organizations have chosen to stop or limit volunteer access and participation.

In the context of the current pandemic, large increases in evictions could have at least two potential negative consequences. One is if homeless shelters increase occupancy in ways that increase the exposure risk to COVID-19. The other is if homeless shelters turn away the recently homeless, who could become unsheltered, and further contribute to the spread of COVID-19. Neither consequence is in the interest of the public health.

The risk of COVID-19 spread associated with unsheltered homelessness (those who are sleeping outside or in places not meant for human habitation) is of great concern to CDC. Over 35% of homeless persons are typically unsheltered.[] The unsheltered homeless are at higher risk for infection when there is community spread of COVID-19. The risks associated with sleeping and living outdoors or in an encampment setting are different than from staying indoors in a congregate setting, such as an emergency shelter or other congregate living facility. While outdoor settings may allow people to increase physical distance between themselves and others, they may also involve exposure to the elements and inadequate access to hygiene, sanitation facilities, health care, and therapeutics.

The latter factors contribute to the further spread of COVID-19. Additionally, research suggests that the population of persons who would be evicted and become homeless would include many who are predisposed to developing severe disease from COVID-19. Five studies have shown an association between eviction and hypertension, which has been associated with more severe outcomes from COVID-19.[] Also, the homeless Start Printed Page 55296often have underlying conditions that increase their risk of severe outcomes of COVID-19.[] Among patients with COVID-19, homelessness has been associated with increased likelihood of hospitalization.[] These public health risks may increase seasonally. Each year, as winter approaches and the temperature drops, many homeless move into shelters to escape the cold and the occupancy of shelters increases.[] At the same time, there is evidence to suggest that the homeless are more susceptible to respiratory tract infections,[] which may include seasonal influenza.

While there are differences in the epidemiology of COVID-19 and seasonal influenza, the potential co-circulation of viruses during periods of increased occupancy in shelters could increase the risk to occupants in those shelters. In short, evictions threaten to increase the spread of COVID-19 as they force people to move, often into close quarters in new shared housing settings with friends or family, or congregate settings such as homeless shelters. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19.

Findings and Action Therefore, I have determined the temporary halt in evictions in this Order constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of COVID-19 throughout the United States. I have further determined that measures by states, localities, or U.S. Territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of COVID-19.[] Based on the convergence of COVID-19, seasonal influenza, and the increased risk of individuals sheltering in close quarters in congregate settings such as homeless shelters, which may be unable to provide adequate social distancing as populations increase, all of which may be exacerbated as fall and winter approach, I have determined that a temporary halt on evictions through December 31, 2020, subject to further extension, modification, or rescission, is appropriate. Therefore, under 42 CFR 70.2, subject to the limitations under the “Applicability” section, a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action shall not evict any covered person from any residential property in any State or U.S.

Territory in which there are documented cases of COVID-19 that provides a level of public-health protections below the requirements listed in this Order. This Order is not a rule within the meaning of the Administrative Procedure Act (“APA”) but rather an emergency action taken under the existing authority of 42 CFR 70.2. In the event that this Order qualifies as a rule under the APA, notice and comment and a delay in effective date are not required because there is good cause to dispense with prior public notice and comment and the opportunity to comment on this Order and the delay in effective date. See 5 U.S.C.

553(b)(3)(B). Considering the public-health emergency caused by COVID-19, it would be impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that could have potentially significant consequences. As discussed above, one potential consequence would be that evicted individuals would move into close quarters in congregate or shared living settings, including homeless shelters, which would put the individuals at higher risk to COVID-19.

Another potential consequence would be if evicted individuals become homeless and unsheltered, and further contribute to the spread of COVID-19. A delay in the effective date of the Order that leads to such consequences would defeat the purpose of the Order and endanger the public health. Immediate action is necessary. Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs has determined that it would be a major rule under the Congressional Review Act (CRA).

But there would not be a delay in its effective date. The agency has determined that for the same reasons, there would be good cause under the CRA to make the requirements herein effective immediately. If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by Federal authorities and cooperating State and local authorities through the provisions of 18 U.S.C.

3559, 3571. 42 U.S.C. 243, 268, 271. And 42 CFR 70.18.

However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Criminal Penalties Under 18 U.S.C. 3559, 3571. 42 U.S.C.

271. And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 if the violation does not result in a death or one year in jail, or both, or a fine of no more than $250,000 if the violation results in a death or one year in jail, or both, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law. The U.S.

Department of Justice may initiate court proceedings as appropriate seeking imposition of these criminal penalties. Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid State and local authorities in the enforcement of their quarantine and Start Printed Page 55297other health regulations and to accept State and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order.

Notice of Available Federal Resources While this order to prevent eviction is effectuated to protect the public health, the States and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the pandemic, including housing assistance. The Department of Housing and Urban Development (HUD) has informed CDC that all HUD grantees—states, cities, communities, and nonprofits—who received Emergency Solutions Grants (ESG) or Community Development Block Grant (CDBG) funds under the CARES Act may use these funds to provide temporary rental assistance, homelessness prevention, or other aid to individuals who are experiencing financial hardship because of the pandemic and are at risk of being evicted, consistent with applicable laws, regulations, and guidance. HUD has further informed CDC that. HUD's grantees and partners play a critical role in prioritizing efforts to support this goal.

As grantees decide how to deploy CDBG-CV and ESG-CV funds provided by the CARES Act, all communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households. HUD stands at the ready to support American communities take these steps to reduce the spread of COVID-19 and maintain economic prosperity. Where gaps are identified, grantees should coordinate across available Federal, non-Federal, and philanthropic funds to ensure these critical needs are sufficiently addressed, and utilize HUD's technical assistance to design and implement programs to support a coordinated response to eviction prevention needs. For program support, including technical assistance, please visit www.hudexchange.info/​program-support.

For further information on HUD resources, tools, and guidance available to respond to the COVID-19 pandemic, State and local officials are directed to visit https://www.hud.gov/​coronavirus. These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties. Similarly, the Department of the Treasury has informed CDC that the funds allocated through the Coronavirus Relief Fund may be used to fund rental assistance programs to prevent eviction. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information.

Effective Date This Order is effective upon publication in the Federal Register and will remain in effect, unless extended, modified, or rescinded, through December 31, 2020. Attachment Declaration Under Penalty of Perjury for the Centers for Disease Control and Prevention's Temporary Halt in Evictions to Prevent Further Spread of COVID-19 This declaration is for tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions (not including foreclosures on home mortgages) to prevent the further spread of COVID-19. Under the CDC's order you must provide a copy of this declaration to your landlord, owner of the residential property where you live, or other person who has a right to have you evicted or removed from where you live. Each adult listed on the lease, rental agreement, or housing contract should complete this declaration.

Unless the CDC order is extended, changed, or ended, the order prevents you from being evicted or removed from where you are living through December 31, 2020. You are still required to pay rent and follow all the other terms of your lease and rules of the place where you live. You may also still be evicted for reasons other than not paying rent or making a housing payment. This declaration is sworn testimony, meaning that you can be prosecuted, go to jail, or pay a fine if you lie, mislead, or omit important information.

I certify under penalty of perjury, pursuant to 28 U.S.C. 1746, that the foregoing are true and correct. I have used best efforts to obtain all available government assistance for rent or housing; [] I either expect to earn no more than $99,000 in annual income for Calendar Year 2020 (or no more than $198,000 if filing a joint tax return), was not required to report any income in 2019 to the U.S. Internal Revenue Service, or received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act.

I am unable to pay my full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, lay-offs, or extraordinary [] out-of-pocket medical expenses. I am using best efforts to make timely partial payments that are as close to the full payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses. If evicted I would likely become homeless, need to move into a homeless shelter, or need to move into a new residence shared by other people who live in close quarters because I have no other available housing options.[] I understand that I must still pay rent or make a housing payment, and comply with other obligations that I may have under my tenancy, lease agreement, or similar contract. I further understand that fees, penalties, or interest for not paying rent or making a housing payment on time as required by my tenancy, lease agreement, or similar contract may still be charged or collected.

I further understand that at the end of this temporary halt on evictions on December 31, 2020, my housing provider may require payment in full for all payments not made prior to and during the temporary halt and failure to pay may make me subject to eviction pursuant to State and local laws. I understand that any false or misleading statements or omissions may result in criminal and civil actions for fines, penalties, damages, or imprisonment. _____ Signature of Declarant Date _____ Authority The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2.

Start Signature Dated. September 1, 2020. Nina B. Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention.

End Signature End Supplemental Information [FR Doc. 2020-19654 Filed 9-1-20. 4:15 pm]BILLING CODE 4163-18-P.

Today, under the leadership of President Trump, buy levitra 5mg the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing the details of a $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution to nursing homes. This distribution is the latest update in buy levitra 5mg the previously announced $5 billion in planned support to nursing homes grappling with the impact of COVID-19. Last week, HHS announced it had delivered an additional $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Other resources are also being dedicated to support training, mentorship and safety improvements in nursing homes."The buy levitra 5mg Trump Administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes," said HHS Secretary Alex Azar.

"By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives."Nursing homes have been particularly hard hit by this pandemic. By tying continued relief payments to patient outcomes, the Trump Administration is demonstrating its commitment to preserving the lives and safety of America's seniors, who are especially vulnerable to COVID-19. Nursing homes will not have to apply to receive a share buy levitra 5mg of this $2 billion incentive payment allocation. HHS will be measuring nursing home performance through required nursing home data submissions and distributing payments based on these data.QualificationsIn order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from the Centers for Medicare &. Medicaid Services (CMS) buy levitra 5mg.

HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider buy levitra 5mg data to inform payment. Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS).Performance and Payment CycleThe incentive payment program is scheduled to be divided into four performance periods (September, October, November, December), lasting a month each with $500 million available to nursing homes in each period. All nursing homes or skilled nursing facilities meeting the previously noted qualifications will be eligible for each of the four performance periods. Nursing homes buy levitra 5mg will be assessed based on a full month's worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month's performance period.MethodologyUsing data from the Centers for Disease Control and Prevention (CDC), HHS will measure nursing homes against a baseline level of infection in the community where a given facility is located.

CDC's Community Profile Reports (CPRs) include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Against this baseline, facilities will buy levitra 5mg have their performance measured on two outcomes. Ability to keep new COVID infection rates low among residents. Ability to keep COVID mortality low among residents.To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) LTCF COVID-19 module. CMS issued guidance in buy levitra 5mg early May requiring that certified nursing facilities submit data to the NHSN COVID-19 Module.

Data from this module will be used to assess nursing home performance and determine incentive payments.HHS will continue to provide more updates as it works to assist providers in slowing the spread of infection while simultaneously offering financial support to these frontline heroes combating the pandemic. Funding for this nursing home incentive effort was made possible from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the buy levitra 5mg Paycheck Protection Program and Health Care Enhancement Act. Incentive payments will be subject to the same Terms and Conditions applicable to the initial infection control payments announced last week (available here).For updates and to learn more about the Provider Relief Program, visit. Hhs.gov/providerrelief.Start Preamble Start Printed Page 55292 Centers for Disease Control and Prevention (CDC), Department of Health and buy levitra 5mg Human Services (HHS). Agency Order.

The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) announces the issuance of an Order under Section 361 of the Public Health Service Act to temporarily halt residential evictions to prevent the further spread of COVID-19. This Order buy levitra 5mg is effective September 4, 2020 through December 31, 2020. Start Further Info Nina Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H21-10, Atlanta, GA 30329. Telephone. 404-639-7000.

Email. Cdcregulations@cdc.gov. End Further Info End Preamble Start Supplemental Information Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths.

Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease. The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal.

People of any age with certain underlying medical conditions, such as cancer, an immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health. According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these best efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease.

Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition. They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19.

Applicability Under this Order, a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. This Order does not apply in any State, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order. Nor does this order apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. In accordance with 42 U.S.C. 264(e), this Order does not preclude State, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order.

This Order is a temporary eviction moratorium to prevent the further spread of COVID-19. This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Renter's or Homeowner's Declaration Attachment A is a Declaration form that tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions to prevent the further spread of COVID-19 may use. To invoke the CDC's order these persons must provide an executed copy of the Declaration form (or a similar declaration under penalty of perjury) to their landlord, owner of the residential property where they live, or other person who has a right to have them evicted or removed from where they live.

Each adult listed on the lease, rental agreement, or housing contract should likewise complete and provide a declaration. Unless the CDC order is extended, changed, or ended, the order prevents these persons from being evicted or removed from where they are living through December 31, 2020. These persons are still required to pay rent and follow all the other terms of their lease and rules of the place where they live. These persons may also still be evicted for reasons other than not paying rent or making a housing Start Printed Page 55293payment. Executed declarations should not be returned to the Federal Government.

Centers for Disease Control and Prevention, Department of Health and Human Services Order Under Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2 Temporary Halt in Residential Evictions To Prevent the Further Spread of COVID-19 Summary Notice and Order. And subject to the limitations under “Applicability”. Under 42 CFR 70.2, a landlord, owner of a residential property, or other person [] with a legal right to pursue eviction or possessory action, shall not evict any covered person from any residential property in any jurisdiction to which this Order applies during the effective period of the Order. Definitions “Available government assistance” means any governmental rental or housing payment benefits available to the individual or any household member.

€œAvailable housing” means any available, unoccupied residential property, or other space for occupancy in any seasonal or temporary housing, that would not violate Federal, State, or local occupancy standards and that would not result in an overall increase of housing cost to such individual. €œCovered person” [] means any tenant, lessee, or resident of a residential property who provides to their landlord, the owner of the residential property, or other person with a legal right to pursue eviction or a possessory action, a declaration under penalty of perjury indicating that. (1) The individual has used best efforts to obtain all available government assistance for rent or housing. (2) The individual either (i) expects to earn no more than $99,000 in annual income for Calendar Year 2020 (or no more than $198,000 if filing a joint tax return),[] (ii) was not required to report any income in 2019 to the U.S. Internal Revenue Service, or (iii) received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act.

(3) the individual is unable to pay the full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, a lay-off, or extraordinary [] out-of-pocket medical expenses. (4) the individual is using best efforts to make timely partial payments that are as close to the full payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses. And (5) eviction would likely render the individual homeless—or force the individual to move into and live in close quarters in a new congregate or shared living setting—because the individual has no other available housing options. €œEvict” and “Eviction” means any action by a landlord, owner of a residential property, or other person with a legal right to pursue eviction or a possessory action, to remove or cause the removal of a covered person from a residential property. This does not include foreclosure on a home mortgage.

€œResidential property” means any property leased for residential purposes, including any house, building, mobile home or land in a mobile home park, or similar dwelling leased for residential purposes, but shall not include any hotel, motel, or other guest house rented to a temporary guest or seasonal tenant as defined under the laws of the State, territorial, tribal, or local jurisdiction. €œState” shall have the same definition as under 42 CFR 70.1, meaning “any of the 50 states, plus the District of Columbia.” “U.S. Territory” shall have the same definition as under 42 CFR 70.1, meaning “any territory (also known as possessions) of the United States, including American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands.” Statement of Intent This Order shall be interpreted and implemented in a manner as to achieve the following objectives. Mitigating the spread of COVID-19 within congregate or shared living settings, or through unsheltered homelessness.

Mitigating the further spread of COVID-19 from one U.S. State or U.S. Territory into any other U.S. State or U.S. Territory.

And supporting response efforts to COVID-19 at the Federal, State, local, territorial, and tribal levels. Background There is currently a pandemic of a respiratory disease (“COVID-19”) caused by a novel coronavirus (SARS-COV-2) that has now spread globally, including cases reported in all fifty states within the United States plus the District of Columbia and U.S. Territories (excepting American Samoa). As of August 24, 2020, there were over 23,000,000 cases of COVID-19 globally resulting in over 800,000 deaths. Over 5,500,000 cases have been identified in the United States, with new cases being reported daily and over 174,000 deaths due to the disease.

The virus that causes COVID-19 spreads very easily and sustainably between people who are in close contact with one another (within about 6 feet), mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. Some people without symptoms may be able to spread the virus. Among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. Severe illness means that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, and may be fatal. People of any age with certain underlying medical conditions, such as cancer, an Start Printed Page 55294immunocompromised state, obesity, serious heart conditions, and diabetes, are at increased risk for severe illness from COVID-19.[] COVID-19 presents a historic threat to public health.

According to one recent study, the mortality associated with COVID-19 during the early phase of the outbreak in New York City was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.[] During the 1918 H1N1 influenza pandemic, there were approximately 50 million influenza-related deaths worldwide, including 675,000 in the United States. To respond to this public health threat, the Federal, State, and local governments have taken unprecedented or exceedingly rare actions, including border closures, restrictions on travel, stay-at-home orders, mask requirements, and eviction moratoria. Despite these significant efforts, COVID-19 continues to spread and further action is needed. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure utilized to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation by people who become ill or who are at risk for severe illness from COVID-19 due to an underlying medical condition.

They also allow State and local authorities to more easily implement stay-at-home and social distancing directives to mitigate the community spread of COVID-19. Furthermore, housing stability helps protect public health because homelessness increases the likelihood of individuals moving into close quarters in congregate settings, such as homeless shelters, which then puts individuals at higher risk to COVID-19. Applicability This Order does not apply in any State, local, territorial, or tribal area with a moratorium on residential evictions that provides the same or greater level of public-health protection than the requirements listed in this Order. In accordance with 42 U.S.C. 264(e), this Order does not preclude State, local, territorial, and tribal authorities from imposing additional requirements that provide greater public-health protection and are more restrictive than the requirements in this Order.

Additionally, this Order shall not apply to American Samoa, which has reported no cases of COVID-19, until such time as cases are reported. This Order is a temporary eviction moratorium to prevent the further spread of COVID-19. This Order does not relieve any individual of any obligation to pay rent, make a housing payment, or comply with any other obligation that the individual may have under a tenancy, lease, or similar contract. Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Nothing in this Order precludes evictions based on a tenant, lessee, or resident.

(1) Engaging in criminal activity while on the premises. (2) threatening the health or safety of other residents; [] (3) damaging or posing an immediate and significant risk of damage to property. (4) violating any applicable building code, health ordinance, or similar regulation relating to health and safety. Or (5) violating any other contractual obligation, other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest). Eviction and Risk of COVID-19 Transmission Evicted renters must move, which leads to multiple outcomes that increase the risk of COVID-19 spread.

Specifically, many evicted renters move into close quarters in shared housing or other congregate settings. According to the Census Bureau American Housing Survey, 32% of renters reported that they would move in with friends or family members upon eviction, which would introduce new household members and potentially increase household crowding.[] Studies show that COVID-19 transmission occurs readily within households. Household contacts are estimated to be 6 times more likely to become infected by an index case of COVID-19 than other close contacts.[] Shared housing is not limited to friends and family. It includes a broad range of settings, including transitional housing, and domestic violence and abuse shelters. Special considerations exist for such housing because of the challenges of maintaining social distance.

Residents often gather closely or use shared equipment, such as kitchen appliances, laundry facilities, stairwells, and elevators. Residents may have unique needs, such as disabilities, cognitive decline, or no access to technology, and thus may find it more difficult to take actions to protect themselves from COVID-19. CDC recommends that shelters provide new residents with a clean mask, keep them isolated from others, screen for symptoms at entry, or arrange for medical evaluations as needed depending on symptoms.[] Accordingly, an influx of new residents at facilities that offer support services could potentially overwhelm staff and, if recommendations are not followed, lead to exposures. Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L.

116-136) to aid individuals and businesses adversely affected by COVID-19. Section 4024 of the CARES Act provided a 120-day moratorium on eviction filings as well as other protections for tenants in certain rental properties with Federal assistance or federally related financing. These protections helped alleviate the public health consequences of tenant displacement during the COVID-19 pandemic. The CARES Act eviction moratorium expired on July 24, 2020.[] The protections in the CARES Act supplemented temporary eviction moratoria and rent freezes implemented by governors and local officials using emergency powers. Researchers estimated that this temporary Federal moratorium provided relief to a material portion of the nation's roughly 43 million renters.[] Start Printed Page 55295Approximately 12.3 million rental units have federally backed financing, representing 28% of renters.

Other data show more than 2 million housing vouchers along with approximately 2 million other federally assisted rental units.[] The Federal moratorium, however, did not reach all renters. Many renters who fell outside the scope of the Federal moratorium were protected under State and local moratoria. In the absence of State and local protections, as many as 30-40 million people in America could be at risk of eviction.[] A wave of evictions on that scale would be unprecedented in modern times.[] A large portion of those who are evicted may move into close quarters in shared housing or, as discussed below, become homeless, thus contributing to the spread of COVID-19. The statistics on interstate moves show that mass evictions would likely increase the interstate spread of COVID-19. Over 35 million Americans, representing approximately 10% of the U.S.

Population, move each year.[] Approximately 15% of moves are interstate.[] Eviction, Homelessness, and Risk of Severe Disease From COVID-19 Evicted individuals without access to housing or assistance options may also contribute to the homeless population, including older adults or those with underlying medical conditions, who are more at risk for severe illness from COVID-19 than the general population.[] In Seattle-King County, 5-15% of people experiencing homelessness between 2018 and 2020 cited eviction as the primary reason for becoming homeless.[] Additionally, some individuals and families who are evicted may originally stay with family or friends, but subsequently seek homeless services. Among people who entered shelters throughout the United States in 2017, 27% were staying with family or friends beforehand.[] People experiencing homelessness are a high-risk population. It may be more difficult for these persons to consistently access the necessary resources in order to adhere to public health recommendations to prevent COVID-19. For instance, it may not be possible to avoid certain congregate settings such as homeless shelters, or easily access facilities to engage in handwashing with soap and water. Extensive outbreaks of COVID-19 have been identified in homeless shelters.[] In Seattle, Washington, a network of three related homeless shelters experienced an outbreak that led to 43 cases among residents and staff members.[] In Boston, Massachusetts, universal COVID-19 testing at a single shelter revealed 147 cases, representing 36% of shelter residents.[] COVID-19 testing in a single shelter in San Francisco led to the identification of 101 cases (67% of those tested).[] Throughout the United States, among 208 shelters reporting universal diagnostic testing data, 9% of shelter clients have tested positive.[] CDC guidance recommends increasing physical distance between beds in homeless shelters.[] To adhere to this guidance, shelters have limited the number of people served throughout the United States.

In many places, considerably fewer beds are available to individuals who become homeless. Shelters that do not adhere to the guidance, and operate at ordinary or increased occupancy, are at greater risk for the types of outbreaks described above. The challenge of mitigating disease transmission in homeless shelters has been compounded because some organizations have chosen to stop or limit volunteer access and participation. In the context of the current pandemic, large increases in evictions could have at least two potential negative consequences. One is if homeless shelters increase occupancy in ways that increase the exposure risk to COVID-19.

The other is if homeless shelters turn away the recently homeless, who could become unsheltered, and further contribute to the spread of COVID-19. Neither consequence is in the interest of the public health. The risk of COVID-19 spread associated with unsheltered homelessness (those who are sleeping outside or in places not meant for human habitation) is of great concern to CDC. Over 35% of homeless persons are typically unsheltered.[] The unsheltered homeless are at higher risk for infection when there is community spread of COVID-19. The risks associated with sleeping and living outdoors or in an encampment setting are different than from staying indoors in a congregate setting, such as an emergency shelter or other congregate living facility.

While outdoor settings may allow people to increase physical distance between themselves and others, they may also involve exposure to the elements and inadequate access to hygiene, sanitation facilities, health care, and therapeutics. The latter factors contribute to the further spread of COVID-19. Additionally, research suggests that the population of persons who would be evicted and become homeless would include many who are predisposed to developing severe disease from COVID-19. Five studies have shown an association between eviction and hypertension, which has been associated with more severe outcomes from COVID-19.[] Also, the homeless Start Printed Page 55296often have underlying conditions that increase their risk of severe outcomes of COVID-19.[] Among patients with COVID-19, homelessness has been associated with increased likelihood of hospitalization.[] These public health risks may increase seasonally. Each year, as winter approaches and the temperature drops, many homeless move into shelters to escape the cold and the occupancy of shelters increases.[] At the same time, there is evidence to suggest that the homeless are more susceptible to respiratory tract infections,[] which may include seasonal influenza.

While there are differences in the epidemiology of COVID-19 and seasonal influenza, the potential co-circulation of viruses during periods of increased occupancy in shelters could increase the risk to occupants in those shelters. In short, evictions threaten to increase the spread of COVID-19 as they force people to move, often into close quarters in new shared housing settings with friends or family, or congregate settings such as homeless shelters. The ability of these settings to adhere to best practices, such as social distancing and other infection control measures, decreases as populations increase. Unsheltered homelessness also increases the risk that individuals will experience severe illness from COVID-19. Findings and Action Therefore, I have determined the temporary halt in evictions in this Order constitutes a reasonably necessary measure under 42 CFR 70.2 to prevent the further spread of COVID-19 throughout the United States.

I have further determined that measures by states, localities, or U.S. Territories that do not meet or exceed these minimum protections are insufficient to prevent the interstate spread of COVID-19.[] Based on the convergence of COVID-19, seasonal influenza, and the increased risk of individuals sheltering in close quarters in congregate settings such as homeless shelters, which may be unable to provide adequate social distancing as populations increase, all of which may be exacerbated as fall and winter approach, I have determined that a temporary halt on evictions through December 31, 2020, subject to further extension, modification, or rescission, is appropriate. Therefore, under 42 CFR 70.2, subject to the limitations under the “Applicability” section, a landlord, owner of a residential property, or other person with a legal right to pursue eviction or possessory action shall not evict any covered person from any residential property in any State or U.S. Territory in which there are documented cases of COVID-19 that provides a level of public-health protections below the requirements listed in this Order. This Order is not a rule within the meaning of the Administrative Procedure Act (“APA”) but rather an emergency action taken under the existing authority of 42 CFR 70.2.

In the event that this Order qualifies as a rule under the APA, notice and comment and a delay in effective date are not required because there is good cause to dispense with prior public notice and comment and the opportunity to comment on this Order and the delay in effective date. See 5 U.S.C. 553(b)(3)(B). Considering the public-health emergency caused by COVID-19, it would be impracticable and contrary to the public health, and by extension the public interest, to delay the issuance and effective date of this Order. A delay in the effective date of the Order would permit the occurrence of evictions—potentially on a mass scale—that could have potentially significant consequences.

As discussed above, one potential consequence would be that evicted individuals would move into close quarters in congregate or shared living settings, including homeless shelters, which would put the individuals at higher risk to COVID-19. Another potential consequence would be if evicted individuals become homeless and unsheltered, and further contribute to the spread of COVID-19. A delay in the effective date of the Order that leads to such consequences would defeat the purpose of the Order and endanger the public health. Immediate action is necessary. Similarly, if this Order qualifies as a rule under the APA, the Office of Information and Regulatory Affairs has determined that it would be a major rule under the Congressional Review Act (CRA).

But there would not be a delay in its effective date. The agency has determined that for the same reasons, there would be good cause under the CRA to make the requirements herein effective immediately. If any provision of this Order, or the application of any provision to any persons, entities, or circumstances, shall be held invalid, the remainder of the provisions, or the application of such provisions to any persons, entities, or circumstances other than those to which it is held invalid, shall remain valid and in effect. This Order shall be enforced by Federal authorities and cooperating State and local authorities through the provisions of 18 U.S.C. 3559, 3571.

42 U.S.C. 243, 268, 271. And 42 CFR 70.18. However, this Order has no effect on the contractual obligations of renters to pay rent and shall not preclude charging or collecting fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract. Criminal Penalties Under 18 U.S.C.

3559, 3571. 42 U.S.C. 271. And 42 CFR 70.18, a person violating this Order may be subject to a fine of no more than $100,000 if the violation does not result in a death or one year in jail, or both, or a fine of no more than $250,000 if the violation results in a death or one year in jail, or both, or as otherwise provided by law. An organization violating this Order may be subject to a fine of no more than $200,000 per event if the violation does not result in a death or $500,000 per event if the violation results in a death or as otherwise provided by law.

The U.S. Department of Justice may initiate court proceedings as appropriate seeking imposition of these criminal penalties. Notice to Cooperating State and Local Officials Under 42 U.S.C. 243, the U.S. Department of Health and Human Services is authorized to cooperate with and aid State and local authorities in the enforcement of their quarantine and Start Printed Page 55297other health regulations and to accept State and local assistance in the enforcement of Federal quarantine rules and regulations, including in the enforcement of this Order.

Notice of Available Federal Resources While this order to prevent eviction is effectuated to protect the public health, the States and units of local government are reminded that the Federal Government has deployed unprecedented resources to address the pandemic, including housing assistance. The Department of Housing and Urban Development (HUD) has informed CDC that all HUD grantees—states, cities, communities, and nonprofits—who received Emergency Solutions Grants (ESG) or Community Development Block Grant (CDBG) funds under the CARES Act may use these funds to provide temporary rental assistance, homelessness prevention, or other aid to individuals who are experiencing financial hardship because of the pandemic and are at risk of being evicted, consistent with applicable laws, regulations, and guidance. HUD has further informed CDC that. HUD's grantees and partners play a critical role in prioritizing efforts to support this goal. As grantees decide how to deploy CDBG-CV and ESG-CV funds provided by the CARES Act, all communities should assess what resources have already been allocated to prevent evictions and homelessness through temporary rental assistance and homelessness prevention, particularly to the most vulnerable households.

HUD stands at the ready to support American communities take these steps to reduce the spread of COVID-19 and maintain economic prosperity. Where gaps are identified, grantees should coordinate across available Federal, non-Federal, and philanthropic funds to ensure these critical needs are sufficiently addressed, and utilize HUD's technical assistance to design and implement programs to support a coordinated response to eviction prevention needs. For program support, including technical assistance, please visit www.hudexchange.info/​program-support. For further information on HUD resources, tools, and guidance available to respond to the COVID-19 pandemic, State and local officials are directed to visit https://www.hud.gov/​coronavirus. These tools include toolkits for Public Housing Authorities and Housing Choice Voucher landlords related to housing stability and eviction prevention, as well as similar guidance for owners and renters in HUD-assisted multifamily properties.

Similarly, the Department of the Treasury has informed CDC that the funds allocated through the Coronavirus Relief Fund may be used to fund rental assistance programs to prevent eviction. Visit https://home.treasury.gov/​policy-issues/​cares/​state-and-local-governments for more information. Effective Date This Order is effective upon publication in the Federal Register and will remain in effect, unless extended, modified, or rescinded, through December 31, 2020. Attachment Declaration Under Penalty of Perjury for the Centers for Disease Control and Prevention's Temporary Halt in Evictions to Prevent Further Spread of COVID-19 This declaration is for tenants, lessees, or residents of residential properties who are covered by the CDC's order temporarily halting residential evictions (not including foreclosures on home mortgages) to prevent the further spread of COVID-19. Under the CDC's order you must provide a copy of this declaration to your landlord, owner of the residential property where you live, or other person who has a right to have you evicted or removed from where you live.

Each adult listed on the lease, rental agreement, or housing contract should complete this declaration. Unless the CDC order is extended, changed, or ended, the order prevents you from being evicted or removed from where you are living through December 31, 2020. You are still required to pay rent and follow all the other terms of your lease and rules of the place where you live. You may also still be evicted for reasons other than not paying rent or making a housing payment. This declaration is sworn testimony, meaning that you can be prosecuted, go to jail, or pay a fine if you lie, mislead, or omit important information.

I certify under penalty of perjury, pursuant to 28 U.S.C. 1746, that the foregoing are true and correct. I have used best efforts to obtain all available government assistance for rent or housing; [] I either expect to earn no more than $99,000 in annual income for Calendar Year 2020 (or no more than $198,000 if filing a joint tax return), was not required to report any income in 2019 to the U.S. Internal Revenue Service, or received an Economic Impact Payment (stimulus check) pursuant to Section 2201 of the CARES Act. I am unable to pay my full rent or make a full housing payment due to substantial loss of household income, loss of compensable hours of work or wages, lay-offs, or extraordinary [] out-of-pocket medical expenses.

I am using best efforts to make timely partial payments that are as close to the full payment as the individual's circumstances may permit, taking into account other nondiscretionary expenses. If evicted I would likely become homeless, need to move into a homeless shelter, or need to move into a new residence shared by other people who live in close quarters because I have no other available housing options.[] I understand that I must still pay rent or make a housing payment, and comply with other obligations that I may have under my tenancy, lease agreement, or similar contract. I further understand that fees, penalties, or interest for not paying rent or making a housing payment on time as required by my tenancy, lease agreement, or similar contract may still be charged or collected. I further understand that at the end of this temporary halt on evictions on December 31, 2020, my housing provider may require payment in full for all payments not made prior to and during the temporary halt and failure to pay may make me subject to eviction pursuant to State and local laws. I understand that any false or misleading statements or omissions may result in criminal and civil actions for fines, penalties, damages, or imprisonment.

_____ Signature of Declarant Date _____ Authority The authority for this Order is Section 361 of the Public Health Service Act (42 U.S.C. 264) and 42 CFR 70.2. Start Signature Dated. September 1, 2020. Nina B.

Witkofsky, Acting Chief of Staff, Centers for Disease Control and Prevention. End Signature End Supplemental Information [FR Doc. 2020-19654 Filed 9-1-20. 4:15 pm]BILLING CODE 4163-18-P.

Levitra cena

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Doris Hutchinson levitra cena wanted to use money from the sale of her late mother’s house to help her grandchildren go to college.Then she learned the University of Virginia Health System was taking $38,000 of the proceeds because a 13-year-old medical bill owed by her deceased brother had somehow turned into a lien on the property. Special Reports UVA Lawsuits Over six years, the state institution filed 36,000 lawsuits against patients seeking a total levitra cena of more than $106 million in unpaid bills, a KHN analysis finds. “It was a mess,” she said. €œThere are bills levitra cena I could pay with that money. I could pay off my car, for one thing.”Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds.An ongoing examination by KHN into hospital billing and collections in Virginia shows just how widespread and destructive they can be.

KHN reported a year ago that UVA Health had sued patients 36,000 times over six years for levitra cena more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system temporarily suspended patient lawsuits and wage garnishments, increased discounts for levitra cena the uninsured and broadened financial assistance, including for cases dating to 2017.Those changes were “a first step” in reforming billing and collection practices, university officials said at the time.However, UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system examined by KHN. VCU Health pledged in March to stop seizing patients’ wages over unpaid bills and to remove all property liens, which are created after a creditor wins a court judgment. Email Sign-Up Subscribe to KHN’s free Morning levitra cena Briefing. Working courthouse-by-courthouse, VCU Health now says it has discovered and released 45,000 property liens filed against patients just in Richmond, its home city, some dating to the 1990s.

There are an estimated 35,000 more in other parts levitra cena of the state. Fifteen thousand of those have been canceled and they are working on the rest, officials said. These figures levitra cena have not been previously reported. The system is part of Virginia Commonwealth University.VCU Health’s total caseload is “a huge number” but perhaps not astonishing given the energy with which many hospital systems sue their patients, said Carolyn Carter, deputy director of the National Consumer Law Center.Despite having levitra cena suspended patient lawsuits, UVA Health has continued to create property liens based on older court cases, court records show. The number of new liens is “small,” said UVA Health spokesperson Eric Swensen.An advisory council of UVA Health officials and community leaders is expected to deliver new recommendations by the end of October, Swensen said.

The council, whose schedule has been slowed by the coronavirus crisis, levitra cena has discussed property liens, Don Gathers, an activist and council member, said in an interview this summer.Nobody knows how many old or new UVA Health liens are scattered through scores of Virginia courthouses. The health system, which has sued patients in almost every county and city in the state, has failed to respond to repeated requests over two years to disclose the number and value of its property liens.But in Albemarle County alone, which surrounds the university’s Charlottesville home, “there are thousands” of UVA Health judgments filed in the land records, which creates a lien, said Circuit Court Clerk Jon Zug.Not just Virginia homes are at risk. UVA Health lawyers search the nation for property or other assets owned by patients with outstanding bills and have filed liens in Maryland, West Virginia, Ohio and Florida, court records show.The system put a lien on a Nevada levitra cena vacation condo owned by Veronica Musie’s family a decade ago over a $30,600 hospital bill, said Musie, who lives in northern Virginia. The family has since paid the levitra cena debt.Virginia property liens expire after 20 years. But UVA Health often renews them.

Since 2017, just in Albemarle County, it has renewed more than three dozen levitra cena liens. That means the medical system could seize families’ home equity until 2039 for bills dating to the last century.UVA Health and other medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking their cut at the settlement levitra cena table. But with 6% simple interest accumulating year after year after the court judgment, as allowed by Virginia law, the final amount owed can be much more than the original charges.UVA Health treated Hutchinson’s brother for heart disease in the early 2000s. The unpaid bill levitra cena was $24,868.

The system laid claim to their mother’s home because he was one of levitra cena her heirs. The claim is up to $38,000 now, she said, because of interest charges. Hutchinson has been disputing it for more than a year.VCU Health and its MCV Physicians affiliate estimate that eliminating two decades of property liens in courthouses across the state, which levitra cena they began to do last year after KHN published its reports, won’t be finished until spring.Richmond was especially problematic. Because releasing 40,000 Richmond liens by hand would have been impractical, VCU Health got a judge’s permission to do it with computer code.Creditors such as UVA and VCU don’t need addresses to create liens. All they have to do is file a judgment in county or city levitra cena land records.

If debtors own any property there, title companies won’t approve a sale until the debt is paid, often with home equity.Often owners don’t know debts exist until paralegals levitra cena unearth them when homes are sold, property pros say. Old debts can create liens on newly acquired real estate.“It could be your grandmother’s house, and as soon as you’ve inherited it, and you’ve got judgments, those [liens] are now attached,” said Richmond Court Clerk Edward Jewett.Frequently debtors own no property, so judgments in the land records expire without hospitals or other creditors getting anything.VCU and MCV had no idea how many liens they had placed across the state until they began investigating last year after KHN’s inquiries, officials said.“It’s an incredibly manual process” to cancel the claims, partly because computer systems at many courthouses prohibit an easy tech solution, said Melinda Hancock, VCU Health’s chief administrative and financial officer. But it’s worth it to remove a burden on patients, she said, adding, “This is an outdated collections practice whose time has come and gone.”But many medical systems still do it, levitra cena consumer debt experts say, noting that obtaining a complete picture of hospital property liens is impossible.Land and judgment records are held by thousands of local court clerks, often using separate computer systems. Records are difficult or impossible to obtain in bulk.“There is not a good nationwide study that I know of that looks at how widespread this is, how many consumers are affected, what’s the average size of a lien,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing.Mike Miller and Kitt Klein are among those hoping UVA Health follows VCU Health in canceling thousands of property liens. They fear a $129,000 judgment won by UVA in 2017 against Miller will cost levitra cena them the equity in their home in Quicksburg, Virginia.They make about $25,000 a year.

Miller, a house painter, was insured but received out-of-network radiation at UVA that doctors said was necessary to treat his lung cancer.After KHN wrote about his case a year ago, benefits firm WellRithms analyzed his UVA bill and found that a commercial insurer would have paid a little more than $13,000, not $129,000, for the treatment.“We know all [health care] providers bill a lot, but usually ‘a lot’ is three to six times what reasonable prices would be,” said Jordan Weintraub, vice president of claims for WellRithms. Trying to collect 10 times as much, she said, “is really out levitra cena there.”UVA Health does not comment on individual patient cases, Swensen said.KHN found last year that UVA frequently sued patients for far more than what the system could have collected from insurance.Early this year Miller and Klein emailed UVA President James Ryan, asking for help in reducing or eliminating the judgment. His office phoned in February, saying it would review the case.“I became very emotional, filled with gratitude,” levitra cena Klein said. €œI couldn’t talk.”Months went by with no contact. Recently a lawyer from the office of Virginia Attorney General Mark Herring offered to settle levitra cena the case for $120,000, Klein said, reducing the bill by only $9,000.

They don’t have the money. Miller’s cancer has levitra cena returned. Interest is mounting at 6%.University officials do not comment on legal levitra cena matters or individual cases, a Ryan spokesperson said. Herring’s office did not respond to requests for comment. Jay Hancock levitra cena.

jhancock@kff.org, @JayHancock1 Related Topics Courts Health Care Costs Health Industry States Hospitals Investigation UVA Lawsuits VirginiaSACRAMENTO — A November ballot initiative to raise property taxes on big-business owners in California is drawing unconventional political support from health care power players and public health leaders.They see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century. The initiative would change California’s property tax system to tax some commercial properties higher than residential properties, which backers say could generate billions to help local governments pay levitra cena for critical public health infrastructure and staffing.Without such additional state or federal funding, local governments could be forced to make deeper budget cuts in health and other departments next year as the COVID-19 pandemic continues to strain city and county finances.“When you’re talking about health care, you’re talking about money,” said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group. €œThis is the major revenue measure on the ballot this year, and it’s an opportunity to fund public health at the place where the main responsibility for public health lies — at the county level.” Email Sign-Up Subscribe to KHN’s free Morning Briefing. At least that’s how health care advocates are casting the tax hike levitra cena. But there’s no guarantee that if the measure passes counties would use new levitra cena revenue to address COVID-19 or other health care needs.

And some rural counties fear they would lose money if the ballot measure passes, which could undercut public health efforts.Support within the health care and local government worlds is not unanimous. The powerful California Hospital Association opposes the measure because it would result in higher taxes on private and investor-owned hospitals, said spokesperson levitra cena Jan Emerson-Shea. Nonprofit hospitals, including those run by Sutter Health, Kaiser Permanente and Dignity Health, are exempt from paying property taxes despite their regular high revenue. They would levitra cena remain exempt under the initiative. (KHN, which produces California Healthline, is not levitra cena affiliated with Kaiser Permanente.)“This new tax will mean millions of dollars will be taken away from patient care, in perpetuity,” Emerson-Shea said.Proposition 15 would amend California’s landmark 1978 property tax initiative, Proposition 13, which capped commercial and residential property tax rates at 1% of assessed value at the time of purchase, and limited annual increases thereafter to 2%.

The drop in property taxes as a result of the initiative decimated a major revenue source for public schools and social welfare programs, leaving many underfunded.Voters are now being asked to allow higher taxes for business owners with commercial holdings valued at more than $3 million. If passed, the measure could generate up to $11.5 billion a year, according to the levitra cena nonpartisan state Legislative Analyst’s Office. It would not apply to residential properties.Forty percent of annual revenue would be distributed to K-12 schools and community colleges, with 60% sent to cities and counties. Nothing in the measure would require new local revenue to be spent on health care, but supporters say it’s their best hope after losing $134 million in state public levitra cena health money this year as one-time funding for specific programs expired. At the same time, slammed by a projected $54 billion deficit, Gov.

Gavin Newsom and state levitra cena lawmakers declined this year to increase funding for local health departments to combat COVID-19 and rebuild public health infrastructure.Sponsors of Proposition 15, including the California Teachers Association and the Service Employees International Union California, argue it’s an overdue change that would tax wealthier enterprises in exchange for funding vital school and health care programs. They point out that the initiative, supported by levitra cena Newsom and Democratic presidential nominee Joe Biden, would require schools and local governments to disclose all new revenue they receive and how money is spent.If passed, money from the measure would begin flowing to schools and counties in 2022 at the earliest.Opponents of the measure, including the California Chamber of Commerce, the California Republican Party and the Howard Jarvis Taxpayers Association, say hiking taxes on commercial property owners would harm struggling businesses hit hard by COVID-related closures.“This is being pushed as a panacea cure-all, but at the end of the day, there is no accountability for where these funds go,” said Michael Bustamante, a spokesperson for the “No on Prop 15” campaign. €œThere are, without question, an infinite number of needs, but there is no specificity with what it can or can’t be spent on.”Kat DeBurgh, executive director of the Health Officers Association of California, which represents the state’s 61 local health officers and has not taken a position on the initiative, said ongoing, unrestricted revenue could actually benefit counties by allowing them to spearhead public health programs that address local needs.At present, counties are limited in what they can do with their public health dollars, she said. Most additional funding in recent years has largely been earmarked for specific programs or diseases, such as hepatitis C and HIV, and counties are not allowed to spend levitra cena it on their COVID-19 response or other public health activities.“Maybe your community’s highest priority is not something easily funded by one of these grants. Many rural areas in our state don’t have access to clean drinking water, for example,” DeBurgh said.

€œAnd our greatest demand — more public health workers — can’t be funded with grants or one-time money.”Health care leaders also argue the initiative could help support community clinics and public hospitals that provide care for uninsured people, who have also suffered financially during the pandemic.“What we’re really trying to avoid is having to balance the budget on the backs levitra cena of people who need services,” said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. €œOur public health system has clear inequities that we need to address, and additional funding can help fill in the gaps at the county level.”Hicks said Planned Parenthood, which provides sex education in California public schools, is supporting the initiative not only to improve levitra cena public health, but also because she worries programs like sex education will be on the chopping block as the state experiences unprecedented job and economic losses.“Those types of programs are the first to get cut when there’s not enough funding,” she said.Small, rural counties could also lose funding, county assessors said.While the initiative would likely raise taxes on large commercial property owners who have seen their land and property appreciate in value over the years, it would eliminate property taxes for other business assets, such as machinery and equipment, for the first $500,000 in value.Counties that haven’t seen land values climb as high as those in coastal regions like the Bay Area may not collect more property taxes while also losing revenue from the tax cut on other business assets.Chuck Leonhardt, the elected assessor for rural Plumas County, projects that his county could be one of the losers.“This would take $90 million in assessed value from our tax roll at the beginning, and then I’d have to reassess 2,000 commercial properties,” he said. €œMany of us rural counties don’t feel we’ll benefit from doing these reappraisals and my expectation is we could lose some money.”Even among supporters in public health, some fear that any potential windfall for counties would be allocated based on the whims of local politics.“Even though I support it, I am skeptical that this money will go to the public health programs and basic infrastructure we so desperately need because public health has no constituency,” said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors.He pointed to Sacramento County, where the sheriff’s department received a larger share of the $181 million in federal COVID-19 relief money than the county public health department.“I’m worried we’ll see the same thing we saw with Sacramento County,” Pomer said. This KHN story first published levitra cena on California Healthline, a service of the California Health Care Foundation. Angela Hart.

ahart@kff.org, @ahartreports Related Topics California Elections Public Health levitra cena COVID-19Can’t see the audio player?. Click here to listen. About This Podcast Health levitra cena care — and how much it costs — is scary. But you’re not alone with this stuff, and knowledge levitra cena is power. €œAn Arm and a Leg” is a podcast about these issues, and its second season is co-produced by KHN.

TikTok mom Shaunna Burns used to be a debt collector, so she knows a few things levitra cena about what’s legal and what’s not when a company contacts you to settle a debt. We fact-checked her advice with a legal expert. Jenifer Bosco, an attorney with the National Consumer Law Center.Bosco levitra cena said most of Burns’ advice totally checks out.A recent report from ProPublica shows that debt collectors have thrived during the pandemic. They’re out in levitra cena force to get people to pay up. But we have rights.

Scroll down for some levitra cena consumer protection resources.You don’t need to have heard our earlier episode about Burns and her story. You can start right here. (Both conversations contain lots of levitra cena strong language, so maybe listen when the kids aren’t around.)Meanwhile, here are links to resources. Burns’ Dealing-With-Debt-Collectors TikTok VideosBe sure to note Jen Bosco’s legal caveats, but Burns will get you in the fighting spirit. €œAn Arm and a Leg” is a co-production of Kaiser Health News levitra cena and Public Road Productions.To keep in touch with “An Arm and a Leg,” subscribe to the newsletter.

You can levitra cena also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.To hear all Kaiser Health News podcasts, click here.And subscribe to “An Arm and a Leg” on iTunes, Pocket Casts, Google Play or Spotify. Related Topics Cost and Quality Health Care Costs Multimedia An Arm and a Leg PodcastsSOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y levitra cena contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede usarse de manera gratuita (detalles). Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado de esta elección, según revela una levitra cena nueva encuesta.

Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).Un mes antes de que el tribunal escuche los argumentos levitra cena de los fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes. La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar. Biden tiene una ventaja de 20 levitra cena puntos. Un 56% prefiere su enfoque, contra un 36% para Trump.De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera en el cargo, lo que indica que los votantes no están satisfechos con el trabajo del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el levitra cena enfoque de Biden, del 50% al 43%.La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%.

Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas y producirían una vacuna antes del día de las elecciones.Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica. El 18% levitra cena eligió el brote de COVID-19 y el 12% mencionó el cuidado de salud en general. Casi una proporción igual, el 29%, optó por la economía.La encuesta se realizó del 7 al 12 de octubre, después del primer levitra cena debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.(KHN es un programa editorialmente independiente de KFF). Emmarie levitra cena Huetteman.

ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs Noticias En Español The Health Law COVID-19 KFF Polls Preexisting ConditionsIn March, Sue Williams-Ward took a new job, with a $1-an-hour raise.The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams levitra cena. Explore Our Database levitra cena KHN and The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened in their final days. Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the levitra cena third had a severe mental illness.

None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not levitra cena respond to multiple phone and email requests for comment about the PPE available to its workers.Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”He said that within three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID levitra cena deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.During the pandemic, home health aides have buttressed the U.S. Health care system by keeping the levitra cena most vulnerable patients — seniors, the disabled, the infirm — out of hospitals.

Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick leave levitra cena and health insurance. And they’ve gotten sick and died — leaving little to their survivors. Email Sign-Up Subscribe levitra cena to KHN’s free Morning Briefing. Speaking out about their work conditions during the pandemic has triggered retaliation by employers, according to representatives of the levitra cena Service Employees International Union in Massachusetts, California and Virginia.

€œIt’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it. €œThis is exactly what structural racism looks like today in our health care system.”Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns levitra cena. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.***Tina, a home health provider, said she levitra cena has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked.

€œIt felt like I was in a Third World country,” she said.The home health agencies levitra cena that Tina and others in this article work for declined to comment on work conditions during the pandemic.In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor law.The Fair Labor levitra cena Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”“A deliberate decision was made to discriminate against colored people — mostly levitra cena women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St. Louis University.In 2015, several of these exceptions were eliminated, and protections for health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University.

€œBut the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project. Berkowitz is also a former OSHA chief. In her view, political and financial decisions in recent years have hollowed out the agency. It now has the fewest inspectors and conducts the fewest inspections per year in its history.Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers.

This loophole protects them from the responsibilities of employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”Should workers contract COVID-19, they are unlikely to receive remuneration or damages.Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said. As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.Many home health providers care for multiple patients, who also bear the consequences of their work conditions. €œIf you think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. €œEven if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work.

Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk getting sick.“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said. €œSo I just pray every day I don’t get it.” Eli Cahan. emcahan@stanford.edu, @emcahan Related Topics Aging Health Industry Public Health COVID-19 Home Health Care Lost On The Frontline.

Doris Hutchinson wanted to use http://cz.keimfarben.de/buy-cheap-levitra/ money from the sale of her late mother’s house to help her grandchildren go to college.Then she learned the University of Virginia Health System was taking $38,000 of the proceeds because a 13-year-old medical bill owed by her deceased brother had somehow turned into a lien on the property buy levitra 5mg. Special Reports UVA Lawsuits Over six years, the state institution buy levitra 5mg filed 36,000 lawsuits against patients seeking a total of more than $106 million in unpaid bills, a KHN analysis finds. “It was a mess,” she said. €œThere are bills I could buy levitra 5mg pay with that money.

I could pay off my car, for one thing.”Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds.An ongoing examination by KHN into hospital billing and collections in Virginia shows just how widespread and destructive they can be. KHN reported a year ago that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care buy levitra 5mg. In response to the articles, the system temporarily suspended patient lawsuits and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.Those changes were buy levitra 5mg “a first step” in reforming billing and collection practices, university officials said at the time.However, UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system examined by KHN. VCU Health pledged in March to stop seizing patients’ wages over unpaid bills and to remove all property liens, which are created after a creditor wins a court judgment.

Email Sign-Up Subscribe to buy levitra 5mg KHN’s free Morning Briefing. Working courthouse-by-courthouse, VCU Health now says it has discovered and released 45,000 property liens filed against patients just in Richmond, its home city, some dating to the 1990s. There are an estimated 35,000 more in other parts buy levitra 5mg of the state. Fifteen thousand of those have been canceled and they are working on the rest, officials said.

These figures buy levitra 5mg have not been previously reported. The system is part of Virginia Commonwealth University.VCU Health’s total caseload is “a huge number” but perhaps not astonishing given the energy with which many hospital systems sue their patients, said Carolyn Carter, deputy director of the National Consumer Law Center.Despite having suspended patient lawsuits, UVA Health has continued to buy levitra 5mg create property liens based on older court cases, court records show. The number of new liens is “small,” said UVA Health spokesperson Eric Swensen.An advisory council of UVA Health officials and community leaders is expected to deliver new recommendations by the end of October, Swensen said. The council, whose schedule has been slowed by the coronavirus crisis, has discussed buy levitra 5mg property liens, Don Gathers, an activist and council member, said in an interview this summer.Nobody knows how many old or new UVA Health liens are scattered through scores of Virginia courthouses.

The health system, which has sued patients in almost every county and city in the state, has failed to respond to repeated requests over two years to disclose the number and value of its property liens.But in Albemarle County alone, which surrounds the university’s Charlottesville home, “there are thousands” of UVA Health judgments filed in the land records, which creates a lien, said Circuit Court Clerk Jon Zug.Not just Virginia homes are at risk. UVA Health lawyers search the nation for property or other assets owned by patients with outstanding bills and have filed liens in Maryland, West Virginia, Ohio and Florida, court records show.The system put a lien on a Nevada vacation condo owned by Veronica Musie’s family a buy levitra 5mg decade ago over a $30,600 hospital bill, said Musie, who lives in northern Virginia. The family has since paid buy levitra 5mg the debt.Virginia property liens expire after 20 years. But UVA Health often renews them.

Since 2017, just in Albemarle County, buy levitra 5mg it has renewed more than three dozen liens. That means the medical system could seize families’ home equity until 2039 for bills dating to the last century.UVA Health and other medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking buy levitra 5mg their cut at the settlement table. But with 6% simple interest accumulating year after year after the court judgment, as allowed by Virginia law, the final amount owed can be much more than the original charges.UVA Health treated Hutchinson’s brother for heart disease in the early 2000s.

The unpaid bill was buy levitra 5mg $24,868. The system laid claim to their mother’s home because he was one of her buy levitra 5mg heirs. The claim is up to $38,000 now, she said, because of interest charges. Hutchinson has been disputing it for more than a year.VCU Health and its MCV Physicians affiliate estimate that eliminating two buy levitra 5mg decades of property liens in courthouses across the state, which they began to do last year after KHN published its reports, won’t be finished until spring.Richmond was especially problematic.

Because releasing 40,000 Richmond liens by hand would have been impractical, VCU Health got a judge’s permission to do it with computer code.Creditors such as UVA and VCU don’t need addresses to create liens. All they have to do is file a judgment in county buy levitra 5mg or city land records. If debtors own any property there, title companies won’t approve a sale until the debt is paid, often with home equity.Often owners don’t know debts buy levitra 5mg exist until paralegals unearth them when homes are sold, property pros say. Old debts can create liens on newly acquired real estate.“It could be your grandmother’s house, and as soon as you’ve inherited it, and you’ve got judgments, those [liens] are now attached,” said Richmond Court Clerk Edward Jewett.Frequently debtors own no property, so judgments in the land records expire without hospitals or other creditors getting anything.VCU and MCV had no idea how many liens they had placed across the state until they began investigating last year after KHN’s inquiries, officials said.“It’s an incredibly manual process” to cancel the claims, partly because computer systems at many courthouses prohibit an easy tech solution, said Melinda Hancock, VCU Health’s chief administrative and financial officer.

But it’s worth it to remove a burden on patients, she said, adding, “This is an outdated collections practice whose time has come and gone.”But many medical systems still do it, consumer debt experts say, noting that obtaining a complete picture of hospital property liens is impossible.Land and judgment records are held by buy levitra 5mg thousands of local court clerks, often using separate computer systems. Records are difficult or impossible to obtain in bulk.“There is not a good nationwide study that I know of that looks at how widespread this is, how many consumers are affected, what’s the average size of a lien,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing.Mike Miller and Kitt Klein are among those hoping UVA Health follows VCU Health in canceling thousands of property liens. They fear a $129,000 judgment won by UVA in 2017 against Miller will cost them the equity in their home in Quicksburg, Virginia.They buy levitra 5mg make about $25,000 a year. Miller, a house painter, was insured but received out-of-network radiation at UVA that doctors said was necessary to treat his lung cancer.After KHN wrote about his case a year ago, benefits firm WellRithms analyzed his UVA bill and found that a commercial insurer would have paid a little more than $13,000, not $129,000, for the treatment.“We know all [health care] providers bill a lot, but usually ‘a lot’ is three to six times what reasonable prices would be,” said Jordan Weintraub, vice president of claims for WellRithms.

Trying to collect buy levitra 5mg 10 times as much, she said, “is really out there.”UVA Health does not comment on individual patient cases, Swensen said.KHN found last year that UVA frequently sued patients for far more than what the system could have collected from insurance.Early this year Miller and Klein emailed UVA President James Ryan, asking for help in reducing or eliminating the judgment. His office phoned in February, saying it would review the case.“I became very emotional, filled with gratitude,” Klein buy levitra 5mg said. €œI couldn’t talk.”Months went by with no contact. Recently a lawyer from the office of Virginia Attorney General buy levitra 5mg Mark Herring offered to settle the case for $120,000, Klein said, reducing the bill by only $9,000.

They don’t have the money. Miller’s cancer has buy levitra 5mg returned. Interest is mounting buy levitra 5mg at 6%.University officials do not comment on legal matters or individual cases, a Ryan spokesperson said. Herring’s office did not respond to requests for comment.

Jay buy levitra 5mg Hancock. jhancock@kff.org, @JayHancock1 Related Topics Courts Health Care Costs Health Industry States Hospitals Investigation UVA Lawsuits VirginiaSACRAMENTO — A November ballot initiative to raise property taxes on big-business owners in California is drawing unconventional political support from health care power players and public health leaders.They see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century. The initiative would change California’s property tax system to tax some commercial properties higher than residential properties, which backers say could generate billions to help local governments pay buy levitra 5mg for critical public health infrastructure and staffing.Without such additional state or federal funding, local governments could be forced to make deeper budget cuts in health and other departments next year as the COVID-19 pandemic continues to strain city and county finances.“When you’re talking about health care, you’re talking about money,” said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group. €œThis is the major revenue measure on the ballot this year, and it’s an opportunity to fund public health at the place where the main responsibility for public health lies — at the county level.” Email Sign-Up Subscribe to KHN’s free Morning Briefing.

At least that’s how health care advocates are casting buy levitra 5mg the tax hike. But there’s no guarantee that if the measure passes counties would use new revenue to address COVID-19 buy levitra 5mg or other health care needs. And some rural counties fear they would lose money if the ballot measure passes, which could undercut public health efforts.Support within the health care and local government worlds is not unanimous. The powerful California Hospital Association opposes the measure because it would result in higher taxes on buy levitra 5mg private and investor-owned hospitals, said spokesperson Jan Emerson-Shea.

Nonprofit hospitals, including those run by Sutter Health, Kaiser Permanente and Dignity Health, are exempt from paying property taxes despite their regular high revenue. They would remain buy levitra 5mg exempt under the initiative. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)“This new tax will mean millions of dollars will be taken away from patient care, in perpetuity,” Emerson-Shea said.Proposition 15 would amend California’s landmark 1978 property tax initiative, Proposition 13, which capped buy levitra 5mg commercial and residential property tax rates at 1% of assessed value at the time of purchase, and limited annual increases thereafter to 2%. The drop in property taxes as a result of the initiative decimated a major revenue source for public schools and social welfare programs, leaving many underfunded.Voters are now being asked to allow higher taxes for business owners with commercial holdings valued at more than $3 million.

If passed, the measure could generate up buy levitra 5mg to $11.5 billion a year, according to the nonpartisan state Legislative Analyst’s Office. It would not apply to residential properties.Forty percent of annual revenue would be distributed to K-12 schools and community colleges, with 60% sent to cities and counties. Nothing in the measure would require new local revenue to be buy levitra 5mg spent on health care, but supporters say it’s their best hope after losing $134 million in state public health money this year as one-time funding for specific programs expired. At the same time, slammed by a projected $54 billion deficit, Gov.

Gavin Newsom and state lawmakers declined this year to increase funding for local health departments to combat COVID-19 and rebuild public health infrastructure.Sponsors of Proposition 15, including the California Teachers Association and the Service Employees International Union California, argue it’s an overdue change that would tax wealthier enterprises in exchange for funding vital school and health buy levitra 5mg care programs. They point out that the initiative, supported by Newsom and Democratic presidential nominee Joe Biden, would require schools and local governments to disclose all new revenue they receive and how money is spent.If passed, money from the measure would begin flowing to schools and counties in 2022 at the earliest.Opponents of the measure, including buy levitra 5mg the California Chamber of Commerce, the California Republican Party and the Howard Jarvis Taxpayers Association, say hiking taxes on commercial property owners would harm struggling businesses hit hard by COVID-related closures.“This is being pushed as a panacea cure-all, but at the end of the day, there is no accountability for where these funds go,” said Michael Bustamante, a spokesperson for the “No on Prop 15” campaign. €œThere are, without question, an infinite number of needs, but there is no specificity with what it can or can’t be spent on.”Kat DeBurgh, executive director of the Health Officers Association of California, which represents the state’s 61 local health officers and has not taken a position on the initiative, said ongoing, unrestricted revenue could actually benefit counties by allowing them to spearhead public health programs that address local needs.At present, counties are limited in what they can do with their public health dollars, she said. Most additional funding in recent years has largely been earmarked for specific programs or diseases, such as hepatitis C and HIV, and counties are not allowed to spend it on their COVID-19 response or other public health buy levitra 5mg activities.“Maybe your community’s highest priority is not something easily funded by one of these grants.

Many rural areas in our state don’t have access to clean drinking water, for example,” DeBurgh said. €œAnd our greatest demand — more public health workers — can’t be funded with grants or one-time money.”Health care leaders also argue the initiative could help support community clinics and public hospitals that provide care for uninsured people, who have also suffered financially during the pandemic.“What we’re really trying to avoid buy levitra 5mg is having to balance the budget on the backs of people who need services,” said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. €œOur public health system has clear inequities that we need to address, and additional funding can help fill in the gaps at the county level.”Hicks said Planned Parenthood, which provides sex education in California public schools, is supporting the initiative not only to improve public health, but also because she worries programs like sex education will be on the chopping block as the state experiences unprecedented job and economic losses.“Those types of programs are the first to get cut when there’s not enough funding,” she said.Small, rural counties could also lose funding, county assessors said.While the initiative would likely raise taxes on large commercial property owners who have seen their land and property appreciate in value over the years, it would eliminate property taxes for other business assets, such as machinery and equipment, for the first $500,000 in value.Counties that haven’t seen land values climb as high as those in coastal regions like the Bay Area may not collect more property taxes while also losing revenue from the tax cut on other business assets.Chuck Leonhardt, the elected assessor for rural Plumas County, projects that his county could be one of the losers.“This would buy levitra 5mg take $90 million in assessed value from our tax roll at the beginning, and then I’d have to reassess 2,000 commercial properties,” he said. €œMany of us rural counties don’t feel we’ll benefit from doing these reappraisals and my expectation is we could lose some money.”Even among supporters in public health, some fear that any potential windfall for counties would be allocated based on the whims of local politics.“Even though I support it, I am skeptical that this money will go to the public health programs and basic infrastructure we so desperately need because public health has no constituency,” said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors.He pointed to Sacramento County, where the sheriff’s department received a larger share of the $181 million in federal COVID-19 relief money than the county public health department.“I’m worried we’ll see the same thing we saw with Sacramento County,” Pomer said.

This KHN story first published on California Healthline, a service of the California Health buy levitra 5mg Care Foundation. Angela Hart. ahart@kff.org, buy levitra 5mg @ahartreports Related Topics California Elections Public Health COVID-19Can’t see the audio player?. Click here to listen.

About This buy levitra 5mg Podcast Health care — and how much it costs — is scary. But you’re buy levitra 5mg not alone with this stuff, and knowledge is power. €œAn Arm and a Leg” is a podcast about these issues, and its second season is co-produced by KHN. TikTok mom Shaunna Burns used to be a debt collector, so she buy levitra 5mg knows a few things about what’s legal and what’s not when a company contacts you to settle a debt.

We fact-checked her advice with a legal expert. Jenifer Bosco, an attorney with the National Consumer Law Center.Bosco said most of Burns’ advice totally checks out.A recent report from ProPublica shows that debt collectors have thrived during the buy levitra 5mg pandemic. They’re out buy levitra 5mg in force to get people to pay up. But we have rights.

Scroll down for some consumer protection resources.You don’t need to have buy levitra 5mg heard our earlier episode about Burns and her story. You can start right here. (Both conversations contain lots of strong language, buy levitra 5mg so maybe listen when the kids aren’t around.)Meanwhile, here are links to resources. Burns’ Dealing-With-Debt-Collectors TikTok VideosBe sure to note Jen Bosco’s legal caveats, but Burns will get you in the fighting spirit.

€œAn Arm and buy levitra 5mg a Leg” is a co-production of Kaiser Health News and Public Road Productions.To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and buy levitra 5mg Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.To hear all Kaiser Health News podcasts, click here.And subscribe to “An Arm and a Leg” on iTunes, Pocket Casts, Google Play or Spotify. Related Topics Cost and Quality Health Care Costs Multimedia An Arm and a Leg PodcastsSOBRE NOTICIAS EN ESPAÑOLNoticias en español es buy levitra 5mg una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos.

Use Nuestro Contenido Este contenido puede usarse de manera gratuita (detalles). Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado buy levitra 5mg de esta elección, según revela una nueva encuesta. Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá buy levitra 5mg a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).Un mes antes de que el tribunal escuche los argumentos de los fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes. La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar.

Biden tiene una ventaja buy levitra 5mg de 20 puntos. Un 56% prefiere su enfoque, contra un 36% para Trump.De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera en el cargo, lo que indica que los votantes no están satisfechos con el trabajo del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el enfoque de Biden, del 50% buy levitra 5mg al 43%.La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%. Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas y producirían una vacuna antes del día de las elecciones.Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica.

El 18% eligió el brote de COVID-19 y el 12% buy levitra 5mg mencionó el cuidado de salud en general. Casi una proporción igual, el 29%, optó por la economía.La buy levitra 5mg encuesta se realizó del 7 al 12 de octubre, después del primer debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.(KHN es un programa editorialmente independiente de KFF). Emmarie buy levitra 5mg Huetteman.

ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs Noticias En Español The Health Law COVID-19 KFF Polls Preexisting ConditionsIn March, Sue Williams-Ward took a new job, with a $1-an-hour raise.The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving buy levitra 5mg turkeys and Christmas hams. Explore Our Database KHN and The Guardian are tracking health care workers who buy levitra 5mg died from COVID-19 and writing about their lives and what happened in their final days. Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women.

One was blind, one was wheelchair-bound, and the third had a severe mental illness buy levitra 5mg. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE available to its workers.Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity buy levitra 5mg and freedom.”He said that within three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of COVID-19.

Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.During the pandemic, home health aides have buttressed the U.S buy levitra 5mg. Health care system by keeping the most vulnerable patients — seniors, the disabled, buy levitra 5mg the infirm — out of hospitals. Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, buy levitra 5mg without overtime pay, hazard pay, sick leave and health insurance.

And they’ve gotten sick and died — leaving little to their survivors. Email Sign-Up Subscribe to KHN’s free Morning buy levitra 5mg Briefing. Speaking out about their work conditions during the pandemic has triggered buy levitra 5mg retaliation by employers, according to representatives of the Service Employees International Union in Massachusetts, California and Virginia. €œIt’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it.

€œThis is exactly what structural racism looks like today in our health care system.”Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.***Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked.

€œIt felt like I was in a Third World country,” she said.The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor law.The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”“A deliberate decision was made to discriminate against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St.

Louis University.In 2015, several of these exceptions were eliminated, and protections for health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. €œBut the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project. Berkowitz is also a former OSHA chief.

In her view, political and financial decisions in recent years have hollowed out the agency. It now has the fewest inspectors and conducts the fewest inspections per year in its history.Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”Should workers contract COVID-19, they are unlikely to receive remuneration or damages.Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said.

As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.Many home health providers care for multiple patients, who also bear the consequences of their work conditions. €œIf you think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. €œEven if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work. Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk getting sick.“I can’t afford not to work.

And my clients, they don’t have anybody but me,” she said. €œSo I just pray every day I don’t get it.” Eli Cahan. emcahan@stanford.edu, @emcahan Related Topics Aging Health Industry Public Health COVID-19 Home Health Care Lost On The Frontline.

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You may be hearing about how virtual care, often described as telehealth or cheap levitra for sale telemedicine, is beneficial during COVID-19 and how health systems are offering virtual access like never before generic levitra from canada. There’s a reason for that, too. For the past few weeks I’ve seen Facebook posts daily from former nursing colleagues in metro Detroit, one of the hardest hit areas in the country, as they provide front-line care to patients with COVID-19. It makes me very proud to call these nurses generic levitra from canada my friends.

As a former emergency department nurse, I recall the feeling of satisfaction knowing that I’ve helped someone on the worst day of their life. One of the best parts of being a nurse is knowing you matter to the only person in health care that truly matters. The patient generic levitra from canada. Several years ago I made the difficult decision to no longer perform bedside nursing and become a nurse administrator.

The biggest loss from my transition is the feeling that what I do matters to the patient. COVID-19 has forced a lot of us to rethink the role we play in health care and what the generic levitra from canada real priority should be. Things that were top priorities three months ago have been rightfully cast aside to either care for patients in a pandemic or prepare for the unknown future of, “When is our turn?. € For me, COVID-19 has reignited the feeling that what I do matters as virtual care has become a powerful tool on the forefront of care during this crisis.

It has also generic levitra from canada shown that many of the powerful rules and regulations that limit virtual care are not needed and should be discarded permanently. When I became the director of virtual care at our organization in 2015 I knew nothing about telehealth. Sure, I had seen a stroke robot in some Emergency Departments, and I had some friends that told me their insurance company lets them FaceTime a doctor for free (spoiler alert. It’s not generic levitra from canada FaceTime).

I was tech-savvy from a consumer perspective and a tech novice from an IT perspective. Nevertheless, my team and I spent the next few years learning as we built one of the higher volume virtual care networks in the state of Michigan. We discovered a lot of barriers that keep virtual care from actually making the lives of generic levitra from canada patients and providers better and we also became experts in working around those barriers. But, there were two obstacles that we could not overcome.

Government regulation and insurance provider willingness to cover virtual visits. These two barriers effectively cripple most legitimate attempts to provide value-added direct-to-consumer virtual care, which I define as using virtual care technologies to provide care outside of our brick-and-mortar facilities, generic levitra from canada most commonly in the patient home. The need to social distance, cancel appointments, close provider offices, keep from overloading emergency departments and urgent cares and shelter in place created instant demand for direct-to-consumer virtual care. In all honesty, I’ve always considered direct-to-consumer virtual care to be the flashy, must-have holiday gift of the year that organizations are convinced will be the way of the future.

If a health system wants to provide on-demand access generic levitra from canada to patients for low-complexity acute conditions, they will easily find plenty of vendors that will sell them their app and their doctors and put the health system’s logo on it. What a health system will struggle with is to find is enough patient demand to cover the high cost. Remember my friends from earlier that told me about the app their insurance gave them?. Nearly all of them followed that generic levitra from canada up by telling me they’ve never actually used it.

I am fortunate that I work for an organization that understands this and instead focuses on how can we provide care that our patients actually want and need from the doctors they want to see. Ironically, this fiscal year we had a corporate top priority around direct-to-consumer virtual care. We wanted to generic levitra from canada expand what we thought were some successful pilots and perform 500 direct-to-consumer visits. This year has been one of the hardest of my leadership career because, frankly, up until a month ago I was about to fail on this top priority.

With only four months left, we were only about halfway there. The biggest problem we ran into was that every great idea a physician brought to me was instantly dead in the water because practically no insurance company would pay generic levitra from canada for it. There are (prior to COVID-19) a plethora of rules around virtual care billing but the simplest way to summarize it is that most virtual care will only be paid if it happens in a rural location and inside of a health care facility. It is extremely limited what will be paid for in the patient home and most of it is so specific that the average patient isn’t eligible to get any in-home virtual care.

Therefore, most good medical uses for direct-to-consumer care would be asking the patient to pay cash or the physician to forgo reimbursement for a visit that would be covered generic levitra from canada if it happened in office. Add to that the massive capital and operating expenses it takes to build a virtual care network and you can see why these programs don’t exist. A month ago I was skeptical we’d have a robust direct-to-consumer program any time soon and then COVID-19 hit. When COVID-19 started to spread rapidly in the United States, regulations and reimbursement generic levitra from canada rules were being stripped daily.

The first change that had major impact is when the Centers for Medicare and Medicaid Services (CMS) announced that they would temporarily begin reimbursing for virtual visits conducted in the patient’s home for COVID-19 and non-COVID related visits. We were already frantically designing a virtual program to handle the wave of COVID-19 screening visits that were overloading our emergency departments and urgent cares. We were having plenty of discussions around generic levitra from canada reimbursement for this clinic. Do we attempt to bill insurances knowing they will likely deny, do we do a cash clinic model or do we do this as a community benefit and eat the cost?.

The CMS waiver gave us hope that we would be compensated for diverting patients away from reimbursed visits to a virtual visit that is more convenient for the patient and aligns with the concept of social distancing. Realistically we don’t know if we will be paid for any generic levitra from canada of this. We are holding all of the bills for at least 90 days while the industry sorts out the rules. I was excited by the reimbursement announcement because I knew we had eliminated one of the biggest direct-to-consumer virtual care barriers.

However, I was quickly generic levitra from canada brought back to reality when I was reminded that HIPAA (Health Insurance Portability and Accountability Act) still existed. I had this crazy idea that during a pandemic we should make it as easy as possible for people to receive virtual care and that the best way to do that was to meet the patient on the device they are most comfortable with and the application (FaceTime, Facebook, Skype, etc.) that they use every day. The problem is nearly every app the consumer uses on a daily basis is banned by HIPAA because “it’s not secure.” I’m not quite sure what a hacker stands to gain by listening into to my doctor and me talk about how my kids yet again gave me strep throat but apparently the concern is great enough to stifle the entire industry. Sure, not every health care discussion is as low-key as strep throat and a patient may want to protect certain topics from generic levitra from canada being discussed over a “non-secure” app but why not let the patient decide through informed consent?.

Regulators could also abandon this all-or-nothing approach and lighten regulations surrounding specific health conditions. The idea http://cz.keimfarben.de/levitra-online-coupons/ that regulations change based on medical situation is not new. For example, in my home state of Michigan, adolescents are essentially considered emancipated if it involves sexual health, mental generic levitra from canada health or substance abuse. Never mind that this same information is freely given over the phone by every office around the country daily without issue, but I digress.

While my job is to innovate new pathways for care, our lawyer’s job is to protect the organization and he, along with IT security, rightfully shot down my consumer applications idea. A few days later I legitimately screamed out loud in joy when the Department of Health and Human generic levitra from canada Services announced that it would use discretion on enforcing HIPAA compliance rules and specifically allowed for use of consumer applications. The elimination of billing restrictions and HIPAA regulations changed what is possible for health care organizations to offer virtually. Unfortunately both changes are listed as temporary and will likely be removed when the pandemic ends.

Six days after the HIPAA changes were announced, we launched a centralized virtual generic levitra from canada clinic for any patient that wanted a direct-to-consumer video visit to be screened by a provider for COVID-19. It allows patients to call in without a referral and most patients are on-screen within five minutes of clicking the link we text them. They don’t have to download an app, create an account or even be an established patient of our health system. It saw over 900 patients generic levitra from canada in the first 12 days it was open.

That is 900 real patients that received care from a physician or advanced practice provider without risking personal exposure and without going to an already overwhelmed ED or urgent care. To date, 70 percent of the patients seen by the virtual clinic did not meet CDC testing criteria for COVID-19. I don’t believe we could have reached even half of these patients had the consumer application restrictions been kept generic levitra from canada. A program like this almost certainly wouldn’t exist if not for the regulations being lifted and even if it did, it would have taken six to 12 months to navigate barriers and implement in normal times.

Sure, the urgency of a pandemic helps but the impact of provider, patients, regulators and payors being on the same page is what fueled this fire. During the virtual clinic’s first two weeks, my team turned its attention to getting generic levitra from canada over 300 providers across 60+ offices virtual so they could see their patients at home. Imagine being an immunocompromised cancer patient right now and being asked to leave your home and be exposed to other people in order to see your oncologist. Direct-to-consumer virtual care is the best way to safely care for these patients and without these temporary waivers it wouldn’t be covered by insurance even if you did navigate the clunky apps that are HIPAA compliant.

Do we really think the immunocompromised cancer patient generic levitra from canada feels any more comfortable every normal flu season?. Is it any more appropriate to ask them to risk exposure to the flu than it is to COVID-19?. And yet we deny them this access in normal times and it quite possibly will be stripped away from them when this crisis is over. Now 300 to 400 patients per day in our health system are seen virtually by their own primary care doctor or specialist for non-COVID related generic levitra from canada visits.

Not a single one of these would have been reimbursed one month ago and I am highly skeptical I would have gotten approval to use the software that connects us to the patient. Lastly, recall that prior to COVID-19, our system had only found 250 total patients that direct-to-consumer care was value-added and wasn’t restricted by regulation or reimbursement. COVID-19 has been a wake-up call to the whole country generic levitra from canada and health care is no exception. It has put priorities in perspective and shined a light on what is truly value-added.

For direct-to-consumer virtual care it has shown us what is possible when we get out of our own way. If a generic levitra from canada regulation has to be removed to allow for care during a crisis then we must question why it exists in the first place. HIPAA regulation cannot go back to its antiquated practices if we are truly going to shift the focus to patient wellness. CMS and private payors must embrace value-added direct-to-consumer virtual care and allow patients the access they deserve.

COVID-19 has forced this industry forward, we cannot generic levitra from canada allow it to regress and be forgotten when this is over. Tom Wood is the director of trauma and virtual care for MidMichigan Health, a non-profit health system headquartered in Midland, Michigan, affiliated with Michigan Medicine, the health care division of the University of Michigan. The views and opinions expressed in this commentary are his own.When dealing with all of the aspects of diabetes, it’s easy to let your feel fall to the bottom of the list. But daily generic levitra from canada care and evaluation is one of the best ways to prevent foot complications.

It’s important to identify your risk factors and take the proper steps in limiting your complications. Two of the biggest complications with diabetes are peripheral neuropathy and ulcer/amputation. Symptoms of peripheral neuropathy include numbness, tingling and/or burning in your feet generic levitra from canada and legs. You can slow the progression of developing neuropathy by making it a point to manage your blood sugars and keep them in the normal range.

If you are experiencing these symptoms, it is important to establish and maintain a relationship with a podiatrist. Your podiatrist can make sure things are looking healthy and bring things to your generic levitra from canada attention to monitor and keep a close eye on. Open wounds or ulcers can develop secondary to trauma, pressure, diabetes, neuropathy or poor circulation. If ulcerations do develop, it’s extremely important to identify the cause and address it.

Ulcers can get worse quickly, so it’s generic levitra from canada necessary to seek immediate medical treatment if you find yourself or a loved one dealing with this complication. Untreated ulcerations often lead to amputation and can be avoided if proper medical attention is sought right away. There are important things to remember when dealing with diabetic foot care. It’s very important to inspect your feet generic levitra from canada daily, especially if you have peripheral neuropathy.

You may have a cut or a sore on your feet that you can’t feel, so your body doesn’t alarm you to check your feet. Be gentle when bathing your feet. Moisturize your feet, but not between your toes generic levitra from canada. Do not treat calluses or corns on your own.

Wear clean, dry socks. Never walk barefoot, and consider socks and shoes made specifically for patients with diabetes.

You may be hearing about how virtual care, levitra 100mg vardenafil often described as telehealth or buy levitra 5mg telemedicine, is beneficial during COVID-19 and how health systems are offering virtual access like never before. There’s a reason for that, too. For the past few weeks I’ve seen Facebook posts daily from former nursing colleagues in metro Detroit, one of the hardest hit areas in the country, as they provide front-line care to patients with COVID-19. It makes me very buy levitra 5mg proud to call these nurses my friends.

As a former emergency department nurse, I recall the feeling of satisfaction knowing that I’ve helped someone on the worst day of their life. One of the best parts of being a nurse is knowing you matter to the only person in health care that truly matters. The patient buy levitra 5mg. Several years ago I made the difficult decision to no longer perform bedside nursing and become a nurse administrator.

The biggest loss from my transition is the feeling that what I do matters to the patient. COVID-19 has forced a lot of us to rethink the role we buy levitra 5mg play in health care and what the real priority should be. Things that were top priorities three months ago have been rightfully cast aside to either care for patients in a pandemic or prepare for the unknown future of, “When is our turn?. € For me, COVID-19 has reignited the feeling that what I do matters as virtual care has become a powerful tool on the forefront of care during this crisis.

It has also shown that many of the powerful rules and regulations that limit buy levitra 5mg virtual care are not needed and should be discarded permanently. When I became the director of virtual care at our organization in 2015 I knew nothing about telehealth. Sure, I had seen a stroke robot in some Emergency Departments, and I had some friends that told me their insurance company lets them FaceTime a doctor for free (spoiler alert. It’s not FaceTime) buy levitra 5mg.

I was tech-savvy from a consumer perspective and a tech novice from an IT perspective. Nevertheless, my team and I spent the next few years learning as we built one of the higher volume virtual care networks in the state of Michigan. We discovered buy levitra 5mg a lot of barriers that keep virtual care from actually making the lives of patients and providers better and we also became experts in working around those barriers. But, there were two obstacles that we could not overcome.

Government regulation and insurance provider willingness to cover virtual visits. These two barriers effectively cripple most legitimate attempts to provide value-added direct-to-consumer virtual care, which I define as using virtual care technologies to provide care outside of our brick-and-mortar facilities, most commonly in the patient home buy levitra 5mg. The need to social distance, cancel appointments, close provider offices, keep from overloading emergency departments and urgent cares and shelter in place created instant demand for direct-to-consumer virtual care. In all honesty, I’ve always considered direct-to-consumer virtual care to be the flashy, must-have holiday gift of the year that organizations are convinced will be the way of the future.

If a health system wants to provide on-demand access to patients for low-complexity acute conditions, they will easily find plenty of vendors that will sell them their app and their doctors and put the health system’s buy levitra 5mg logo on it. What a health system will struggle with is to find is enough patient demand to cover the high cost. Remember my friends from earlier that told me about the app their insurance gave them?. Nearly all of them followed that up by telling me they’ve never actually used it buy levitra 5mg.

I am fortunate that I work for an organization that understands this and instead focuses on how can we provide care that our patients actually want and need from the doctors they want to see. Ironically, this fiscal year we had a corporate top priority around direct-to-consumer virtual care. We wanted to expand what we thought were some successful pilots and perform 500 direct-to-consumer buy levitra 5mg visits. This year has been one of the hardest of my leadership career because, frankly, up until a month ago I was about to fail on this top priority.

With only four months left, we were only about halfway there. The biggest problem we ran into was that every great idea a physician brought to buy levitra 5mg me was instantly dead in the water because practically no insurance company would pay for it. There are (prior to COVID-19) a plethora of rules around virtual care billing but the simplest way to summarize it is that most virtual care will only be paid if it happens in a rural location and inside of a health care facility. It is extremely limited what will be paid for in the patient home and most of it is so specific that the average patient isn’t eligible to get any in-home virtual care.

Therefore, most good medical uses for direct-to-consumer buy levitra 5mg care would be asking the patient to pay cash or the physician to forgo reimbursement for a visit that would be covered if it happened in office. Add to that the massive capital and operating expenses it takes to build a virtual care network and you can see why these programs don’t exist. A month ago I was skeptical we’d have a robust direct-to-consumer program any time soon and then COVID-19 hit. When COVID-19 started buy levitra 5mg to spread rapidly in the United States, regulations and reimbursement rules were being stripped daily.

The first change that had major impact is when the Centers for Medicare and Medicaid Services (CMS) announced that they would temporarily begin reimbursing for virtual visits conducted in the patient’s home for COVID-19 and non-COVID related visits. We were already frantically designing a virtual program to handle the wave of COVID-19 screening visits that were overloading our emergency departments and urgent cares. We buy levitra 5mg were having plenty of discussions around reimbursement for this clinic. Do we attempt to bill insurances knowing they will likely deny, do we do a cash clinic model or do we do this as a community benefit and eat the cost?.

The CMS waiver gave us hope that we would be compensated for diverting patients away from reimbursed visits to a virtual visit that is more convenient for the patient and aligns with the concept of social distancing. Realistically we don’t know if we will be paid buy levitra 5mg for any of this. We are holding all of the bills for at least 90 days while the industry sorts out the rules. I was excited by the reimbursement announcement because I knew we had eliminated one of the biggest direct-to-consumer virtual care barriers.

However, I was quickly brought back to reality when I buy levitra 5mg was reminded that HIPAA (Health Insurance Portability and Accountability Act) still existed. I had this crazy idea that during a pandemic we should make it as easy as possible for people to receive virtual care and that the best way to do that was to meet the patient on the device they are most comfortable with and the application (FaceTime, Facebook, Skype, etc.) that they use every day. The problem is nearly every app the consumer uses on a daily basis is banned by HIPAA because “it’s not secure.” I’m not quite sure what a hacker stands to gain by listening into to my doctor and me talk about how my kids yet again gave me strep throat but apparently the concern is great enough to stifle the entire industry. Sure, not buy levitra 5mg every health care discussion is as low-key as strep throat and a patient may want to protect certain topics from being discussed over a “non-secure” app but why not let the patient decide through informed consent?.

Regulators could also abandon this all-or-nothing approach and lighten regulations surrounding specific health conditions. The idea that http://cz.keimfarben.de/buy-cheap-levitra/ regulations change based on medical situation is not new. For example, in my home buy levitra 5mg state of Michigan, adolescents are essentially considered emancipated if it involves sexual health, mental health or substance abuse. Never mind that this same information is freely given over the phone by every office around the country daily without issue, but I digress.

While my job is to innovate new pathways for care, our lawyer’s job is to protect the organization and he, along with IT security, rightfully shot down my consumer applications idea. A few days later I legitimately screamed buy levitra 5mg out loud in joy when the Department of Health and Human Services announced that it would use discretion on enforcing HIPAA compliance rules and specifically allowed for use of consumer applications. The elimination of billing restrictions and HIPAA regulations changed what is possible for health care organizations to offer virtually. Unfortunately both changes are listed as temporary and will likely be removed when the pandemic ends.

Six days after the HIPAA changes were announced, we launched a centralized virtual clinic for any patient that buy levitra 5mg wanted a direct-to-consumer video visit to be screened by a provider for COVID-19. It allows patients to call in without a referral and most patients are on-screen within five minutes of clicking the link we text them. They don’t have to download an app, create an account or even be an established patient of our health system. It saw over 900 buy levitra 5mg patients in the first 12 days it was open.

That is 900 real patients that received care from a physician or advanced practice provider without risking personal exposure and without going to an already overwhelmed ED or urgent care. To date, 70 percent of the patients seen by the virtual clinic did not meet CDC testing criteria for COVID-19. I don’t believe we could have reached buy levitra 5mg even half of these patients had the consumer application restrictions been kept. A program like this almost certainly wouldn’t exist if not for the regulations being lifted and even if it did, it would have taken six to 12 months to navigate barriers and implement in normal times.

Sure, the urgency of a pandemic helps but the impact of provider, patients, regulators and payors being on the same page is what fueled this fire. During the buy levitra 5mg virtual clinic’s first two weeks, my team turned its attention to getting over 300 providers across 60+ offices virtual so they could see their patients at home. Imagine being an immunocompromised cancer patient right now and being asked to leave your home and be exposed to other people in order to see your oncologist. Direct-to-consumer virtual care is the best way to safely care for these patients and without these temporary waivers it wouldn’t be covered by insurance even if you did navigate the clunky apps that are HIPAA compliant.

Do we really buy levitra 5mg think the immunocompromised cancer patient feels any more comfortable every normal flu season?. Is it any more appropriate to ask them to risk exposure to the flu than it is to COVID-19?. And yet we deny them this access in normal times and it quite possibly will be stripped away from them when this crisis is over. Now 300 to 400 patients per day in our health system are seen buy levitra 5mg virtually by their own primary care doctor or specialist for non-COVID related visits.

Not a single one of these would have been reimbursed one month ago and I am highly skeptical I would have gotten approval to use the software that connects us to the patient. Lastly, recall that prior to COVID-19, our system had only found 250 total patients that direct-to-consumer care was value-added and wasn’t restricted by regulation or reimbursement. COVID-19 has been a wake-up call to the whole country and health care is no exception buy levitra 5mg. It has put priorities in perspective and shined a light on what is truly value-added.

For direct-to-consumer virtual care it has shown us what is possible when we get out of our own way. If a regulation has to be buy levitra 5mg removed to allow for care during a crisis then we must question why it exists in the first place. HIPAA regulation cannot go back to its antiquated practices if we are truly going to shift the focus to patient wellness. CMS and private payors must embrace value-added direct-to-consumer virtual care and allow patients the access they deserve.

COVID-19 has forced this industry forward, we cannot allow buy levitra 5mg it to regress and be forgotten when this is over. Tom Wood is the director of trauma and virtual care for MidMichigan Health, a non-profit health system headquartered in Midland, Michigan, affiliated with Michigan Medicine, the health care division of the University of Michigan. The views and opinions expressed in this commentary are his own.When dealing with all of the aspects of diabetes, it’s easy to let your feel fall to the bottom of the list. But daily care and evaluation buy levitra 5mg is one of the best ways to prevent foot complications.

It’s important to identify your risk factors and take the proper steps in limiting your complications. Two of the biggest complications with diabetes are peripheral neuropathy and ulcer/amputation. Symptoms buy levitra 5mg of peripheral neuropathy include numbness, tingling and/or burning in your feet and legs. You can slow the progression of developing neuropathy by making it a point to manage your blood sugars and keep them in the normal range.

If you are experiencing these symptoms, it is important to establish and maintain a relationship with a podiatrist. Your podiatrist can make sure things are looking healthy buy levitra 5mg and bring things to your attention to monitor and keep a close eye on. Open wounds or ulcers can develop secondary to trauma, pressure, diabetes, neuropathy or poor circulation. If ulcerations do develop, it’s extremely important to identify the cause and address it.

Ulcers can get worse quickly, so it’s buy levitra 5mg necessary to seek immediate medical treatment if you find yourself or a loved one dealing with this complication. Untreated ulcerations often lead to amputation and can be avoided if proper medical attention is sought right away. There are important things to remember when dealing with diabetic foot care. It’s very important to inspect buy levitra 5mg your feet daily, especially if you have peripheral neuropathy.

You may have a cut or a sore on your feet that you can’t feel, so your body doesn’t alarm you to check your feet. Be gentle when bathing your feet. Moisturize your feet, buy levitra 5mg but not between your toes. Do not treat calluses or corns on your own.

Wear clean, dry socks. Never walk barefoot, and consider socks and shoes made specifically for patients with diabetes.

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Western NSW residents will have even greater access to mental health support with the opening of a new Lifeline centre in Dubbo.Minister for Mental Health Bronnie Taylor will open the new, purpose-built centre today, thanks to $600,000 in special funding from the NSW Government.“We want people living in the Central West to be able to access timely support from counsellors who understand their local community and the pressures they might be under,” Mrs Taylor said.“As well as establishing a dedicated Lifeline presence in Dubbo, the funding will also allow Lifeline Central West to triple the number of crisis telephone calls answered in Dubbo and its surrounds.”Member for Dubbo Dugald Saunders said the centre comes at a critical time for his community.“The brutal forces of drought, COVID-19 and financial uncertainty are taking a toll on the strongest and most resilient among us,” Mr Saunders said.“One of my priorities after being elected was to see Lifeline’s local footprint expanded and supported, and funding for an appropriate building has been a key component of that.“It’s important for people to know they can lean on trained counsellors who live in the area and know the situations confronting people in central west NSW.”The new centre will also be the base for the Rapid Community Support Program (Rapid) – an outreach program which goes directly to towns hit by significant events such as drought and bushfire to provide counselling and support within their own community.The service received comprar levitra a $500,000 boost from the NSW Government to enable it to continue operations as part of an additional $6 million investment provided to Lifeline in response to the COVID-19 pandemic.CEO of Lifeline Central West Stephanie Robinson said the Dubbo-based team willserve a vast area, including Wellington, Narromine, Mendooran, Coonabarabran, Coonamble, Walgett, Bourke and Lightning Ridge.“Our new centre will be a safe space for people to have group or one-on-one counselling sessions and will also serve as a base for our trained volunteers to provide community outreach,” Ms Robinson said.Lifeline Central West is a not-for-profit organisation with offices in Bathurst, Orange and Dubbo with nine full-time staff and approximately 130 trained volunteers. The NSW Government has invested over $25 million in Lifeline over 4 years.As part of SafeWork Month 2020, a number of prominent business and industry leaders have been appointed to help drive positive change by breaking down the barriers and stigma associated with mental health in NSW workplaces.Minister for Better Regulation and Innovation Kevin Anderson and Minister for Mental Health Bronnie Taylor today announced the NSW Government has appointed 12 ambassadors to champion the importance of good mental health in the workplace.Mr Anderson said the ambassadors will play a critical role in assisting the NSW Government meet its target of 90,000 business taking effective action to create work environments which benefit mental health by 2022.“Statistically we know that one-in-six people struggle with their mental health, and I would suggest those figures are conservative given the current challenging social and economic environment,” Mr Anderson said.“The ambassadors will work alongside us to send a message to employees in every corner of NSW that if you are struggling and need help, we will be there for you.”Among the new mental health ambassadors are Landcom CEO and Lifeline Chairman John Brogden AM, Westpac Group Chief Mental Health Officer David Burroughs and Business Chicks CEO Olivia Ruello.Mr Anderson said there will also be significant financial benefits for businesses.“The financial cost of mental health to NSW employers is $2.8 billion a year, but for every dollar invested into improving culture and outcomes for those living with mental ill-health, there is a return on investment of up to four dollars,” Mr Anderson said.“Our ambassadors recognise that a mentally healthy workplace is good business, and have committed to continuing the great work they do to support their workers and to encourage others in their industry to do the same.”Mrs Taylor said the event is comprar levitra another example of the NSW Government’s commitment to leading the nation in mental health reform.“Most of us spend about one-third or more of our waking lives at work. It’s a huge part of what we do and can have a huge impact on our mental health in a positive or negative way,” Mrs Taylor said.“Everyone in the workplace can contribute to a culture where people feel safe and supported to talk about mental health and it’s really encouraging to see so many leaders from NSW’s business sector stepping up.” For more information please visit SafeWork NSW. comprar levitra.

Western NSW residents will have even greater access to mental health support with the opening of a new Lifeline centre in Dubbo.Minister for Mental Health Bronnie Taylor will open the new, purpose-built centre today, thanks to $600,000 in special funding from the NSW Government.“We want people living in the Central West to be able to access timely support from counsellors who understand their local community and the pressures they might be under,” Mrs Taylor said.“As well as establishing a dedicated Lifeline presence in Dubbo, the funding will also allow Lifeline Central West to triple the number of crisis telephone calls answered in Dubbo and its surrounds.”Member for Dubbo Dugald Saunders said the centre comes at a critical time for his community.“The brutal forces of drought, COVID-19 and financial uncertainty are taking a toll on the strongest and most resilient among us,” Mr Saunders said.“One of my priorities after being elected was to see Lifeline’s local footprint expanded and supported, and funding for an appropriate building has been a key component of that.“It’s important for people to know they can lean on trained counsellors buy levitra 5mg who live in the area and know the situations confronting people in central west NSW.”The new centre will also be the base for the Rapid Community Support Program (Rapid) – an outreach program which goes directly to towns hit by significant events such as drought and bushfire to provide counselling and support within their own community.The service received a $500,000 boost from the NSW Government to enable it to continue operations as part of an additional $6 million investment provided to Lifeline in response to the COVID-19 pandemic.CEO of Lifeline Central West Stephanie Robinson said the Dubbo-based team willserve a vast area, including Wellington, Narromine, Mendooran, Coonabarabran, Coonamble, Walgett, Bourke and Lightning Ridge.“Our new centre will be a safe space for people to have group or one-on-one counselling levitra store sessions and will also serve as a base for our trained volunteers to provide community outreach,” Ms Robinson said.Lifeline Central West is a not-for-profit organisation with offices in Bathurst, Orange and Dubbo with nine full-time staff and approximately 130 trained volunteers. The NSW Government has invested over $25 million in Lifeline over 4 years.As part of SafeWork Month 2020, a number of prominent business and industry leaders have been appointed to help drive positive change by breaking down the barriers and stigma associated with mental health in NSW workplaces.Minister for Better Regulation and Innovation Kevin Anderson and Minister for Mental Health Bronnie Taylor today announced the NSW Government has appointed 12 ambassadors to champion buy levitra 5mg the importance of good mental health in the workplace.Mr Anderson said the ambassadors will play a critical role in assisting the NSW Government meet its target of 90,000 business taking effective action to create work environments which benefit mental health by 2022.“Statistically we know that one-in-six people struggle with their mental health, and I would suggest those figures are conservative given the current challenging social and economic environment,” Mr Anderson said.“The ambassadors will work alongside us to send a message to employees in every corner of NSW that if you are struggling and need help, we will be there for you.”Among the new mental health ambassadors are Landcom CEO and Lifeline Chairman John Brogden AM, Westpac Group Chief Mental Health Officer David Burroughs and Business Chicks CEO Olivia Ruello.Mr Anderson said there will also be significant financial benefits for businesses.“The financial cost of mental health to NSW employers is $2.8 billion a year, but for every dollar invested into improving culture and outcomes for those living with mental ill-health, there is a return on investment of up to four dollars,” Mr Anderson said.“Our ambassadors recognise that a mentally healthy workplace is good business, and have committed to continuing the great work they do to support their workers and to encourage others in their industry to do the same.”Mrs Taylor said the event is another example of the NSW Government’s commitment to leading the nation in mental health reform.“Most of us spend about one-third or more of our waking lives at work. It’s a huge part of what we do and can have a huge impact on our mental health in a positive or negative way,” Mrs Taylor said.“Everyone in the workplace can contribute to a culture where people feel safe and supported to talk about buy levitra 5mg mental health and it’s really encouraging to see so many leaders from NSW’s business sector stepping up.” For more information please visit SafeWork NSW..

Dernière modification : 11.11.2020